Provider Demographics
NPI:1922757483
Name:HERNANDEZ CRUZ, YUDELKYS (RBT)
Entity Type:Individual
Prefix:
First Name:YUDELKYS
Middle Name:
Last Name:HERNANDEZ CRUZ
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 1:15333 SW 40TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5408
Mailing Address - Country:US
Mailing Address - Phone:786-537-9056
Mailing Address - Fax:
Practice Address - Street 1:15333 SW 40TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5408
Practice Address - Country:US
Practice Address - Phone:786-537-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-180070106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111530600Medicaid