Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-21-151236 | FL |
NPI | 1003406976 |
---|---|
Provider Name | Joel Hernandez Rodriguez |
First Address | Miami, FL 33185-3815 |
Second Address | Miami, FL 33185-3815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2021 |
Last Update Date | 24/01/2021 |