Provider Demographics
NPI:1518788710
Name:CARMONA HERNANDEZ, RAUDEL
Entity type:Individual
Prefix:
First Name:RAUDEL
Middle Name:
Last Name:CARMONA HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11524 ENGLISH ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4403
Mailing Address - Country:US
Mailing Address - Phone:786-870-7396
Mailing Address - Fax:
Practice Address - Street 1:100 BUENAVENTURA BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-4513
Practice Address - Country:US
Practice Address - Phone:407-201-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24380935106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician