Provider Demographics
NPI:1174273437
Name:HERNANDEZ PEREZ, CINTHIA (RBT-18-72572)
Entity Type:Individual
Prefix:
First Name:CINTHIA
Middle Name:
Last Name:HERNANDEZ PEREZ
Suffix:
Gender:F
Credentials:RBT-18-72572
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 RAVIDA CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5589
Mailing Address - Country:US
Mailing Address - Phone:407-575-1470
Mailing Address - Fax:
Practice Address - Street 1:1318 RAVIDA CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5589
Practice Address - Country:US
Practice Address - Phone:407-575-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH655-100-91-610-0Medicaid