Provider Demographics
NPI:1093366429
Name:HERNANDEZ, MAURIA MARIA (RBT)
Entity Type:Individual
Prefix:MS
First Name:MAURIA
Middle Name:MARIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 NW 79TH AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6533
Mailing Address - Country:US
Mailing Address - Phone:786-208-3481
Mailing Address - Fax:
Practice Address - Street 1:4134 NW 79TH AVE APT 1A
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6533
Practice Address - Country:US
Practice Address - Phone:786-208-3481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT1976212106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
H65555383687OtherLICENSE