1851062996 NPI number — JUANA UBIERA FERNANDEZ RBT

Table of content: MRS. LOUANN L. KENDALL DNP, ACNP-BC (NPI 1285736082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851062996 NPI number — JUANA UBIERA FERNANDEZ RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UBIERA FERNANDEZ
Provider First Name:
JUANA
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:
1851062996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3341 W MAYAGUANA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANTANA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33462-6828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-909-5276
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7711 N MILITARY TRL STE 1008
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-6506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-480-1075
Provider Business Practice Location Address Fax Number:
561-584-5836
Provider Enumeration Date:
09/27/2021

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 , with the licence number:  RBT-20-144868 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X , with the licence number: RBT-20-144846 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 108876400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: RBT-20-144846 . This is a "BACB" identifier . This identifiers is of the category "OTHER".
  • Identifier: 108876400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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