Provider Demographics
NPI:1689452864
Name:HERNANDEZ ARIAS, LEUDDIS YOEL (RBT-23-297647)
Entity Type:Individual
Prefix:
First Name:LEUDDIS
Middle Name:YOEL
Last Name:HERNANDEZ ARIAS
Suffix:
Gender:M
Credentials:RBT-23-297647
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1518
Mailing Address - Country:US
Mailing Address - Phone:239-888-4612
Mailing Address - Fax:
Practice Address - Street 1:1102 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1518
Practice Address - Country:US
Practice Address - Phone:239-888-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-297647106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician