Provider Demographics
NPI:1023765195
Name:NUNEZ HERNANDEZ, CARLOS (RBT)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:NUNEZ 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 1:220 CULTURAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1278
Mailing Address - Country:US
Mailing Address - Phone:305-384-0980
Mailing Address - Fax:
Practice Address - Street 1:4831 CORONADO PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9516
Practice Address - Country:US
Practice Address - Phone:786-815-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-206040106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician