Provider Demographics
NPI:1962999458
Name:FERNANDEZ, ROZINA J (RBT)
Entity type:Individual
Prefix:MRS
First Name:ROZINA
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E STAN SCHLUETER LOOP STE 107
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5482
Mailing Address - Country:US
Mailing Address - Phone:727-278-2479
Mailing Address - Fax:706-569-7324
Practice Address - Street 1:1200 E STAN SCHLUETER LOOP STE 107
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5482
Practice Address - Country:US
Practice Address - Phone:727-278-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX22-229177106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health