MEDICARE: YANEXIS FERNANDEZ

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-20-122059	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720737760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANEXIS FERNANDEZ

Provider Business Mailing Address
First Line	:	202 E 35TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-2630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 E 35TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-2630
Country	:	US
Telephone Number	:	786-488-8443
Fax Number	:

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

Provider Enumeration Date	:	03/18/2022
Last Update Date	:	11/07/2024

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Directions to “ YANEXIS FERNANDEZ ” Practice Location

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