MEDICARE: GRETEL HERNANDEZ RBT-24-322973

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-322973	FL

General Provider Information

NPI Number	:	1679335673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETEL HERNANDEZ RBT-24-322973

Provider Business Mailing Address
First Line	:	170 14TH ST NE
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-9469
Country	:	US
Telephone Number	:	239-399-0346
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 14TH ST NE
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-9469
Country	:	US
Telephone Number	:	239-399-0346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	05/12/2026

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