MEDICARE: THAIS COELLO HERNANDEZ

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

General Provider Information

NPI Number	:	1801641162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAIS COELLO HERNANDEZ

Provider Business Mailing Address
First Line	:	8300 NW 53RD ST STE 350
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33166-7712
Country	:	US
Telephone Number	:	305-342-7643
Fax Number	:

Provider Business Practice Location Address
First Line	:	5810 W 18TH LN APT 105
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-8911
Country	:	US
Telephone Number	:	305-842-1365
Fax Number	:

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

Provider Enumeration Date	:	04/20/2024
Last Update Date	:	04/20/2024

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Directions to “ THAIS COELLO HERNANDEZ ” Practice Location

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