MEDICARE: LEONARDO 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	RBT-25-430579	FL

General Provider Information

NPI Number	:	1801687298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARDO HERNANDEZ

Provider Business Mailing Address
First Line	:	4939 SW 144TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-5062
Country	:	US
Telephone Number	:	786-597-8054
Fax Number	:	786-597-8054

Provider Business Practice Location Address
First Line	:	4939 SW 144TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-5062
Country	:	US
Telephone Number	:	786-597-8054
Fax Number	:	786-597-8054

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

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	05/14/2025

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Directions to “ LEONARDO HERNANDEZ ” Practice Location

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