Provider Demographics
NPI:1760005029
Name:HERNANDEZ, YANCARLO (RBT)
Entity Type:Individual
Prefix:
First Name:YANCARLO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2413
Mailing Address - Country:US
Mailing Address - Phone:786-878-3267
Mailing Address - Fax:
Practice Address - Street 1:11531 SW 142ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7008
Practice Address - Country:US
Practice Address - Phone:786-878-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-116462106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician