Provider Demographics
NPI:1336867308
Name:HERNANDEZ GEORGE, LUIS FELIPE (RBT-21-157451)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:FELIPE
Last Name:HERNANDEZ GEORGE
Suffix:
Gender:M
Credentials:RBT-21-157451
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 41ST ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-8324
Mailing Address - Country:US
Mailing Address - Phone:786-569-0092
Mailing Address - Fax:
Practice Address - Street 1:3808 33RD ST SW
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-4212
Practice Address - Country:US
Practice Address - Phone:239-337-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty