Provider Demographics
NPI:1598504102
Name:HERNANDEZ PEREZ, EDGAR A (RBT)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:A
Last Name:HERNANDEZ PEREZ
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 1:3244 RANDALL BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-5595
Mailing Address - Country:US
Mailing Address - Phone:786-398-1748
Mailing Address - Fax:
Practice Address - Street 1:3244 RANDALL BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-5595
Practice Address - Country:US
Practice Address - Phone:786-398-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-154803106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician