Individual provider · NPI-1

Maydelis Fernandez

Behavior Technician · Doral, FL

NPI number1477902138
StatusActive
Last updated in NPPESAug 22, 2019

Details

NPI
1477902138
Entity type
Individual (NPI-1)
Name
Maydelis Fernandez
Sex
Female
Sole proprietor
No
Enumeration date
Jun 3, 2016
Last updated
Aug 22, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
106S00000X Behavior TechnicianRBT15-10600FLYes
247200000X Technician, Other1510600FL

Practice location

10776 Nw 83rd Ter Unit 4
Doral, FL 33178-1692

Phone 305-587-0176

Mailing address

15391 Sw 14th Ln
Miami, FL 33194-2669

Phone 305-587-0176

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