1689287740 NPI number — MAIDELYS DE VERA HERNANDEZ RBT

Table of content: MAIDELYS DE VERA HERNANDEZ RBT (NPI 1689287740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689287740 NPI number — MAIDELYS DE VERA HERNANDEZ RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE VERA HERNANDEZ
Provider First Name:
MAIDELYS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689287740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3508 WINDY WALK WAY APT 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32837-7343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-682-7402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14789 MAGNOLIA RIDGE LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER GARDEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34787-5635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-444-8320
Provider Business Practice Location Address Fax Number:
407-641-3926
Provider Enumeration Date:
08/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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