Provider Demographics
NPI:1548965478
Name:HERNANDEZ, MARTHA KARLA (RBT-20-112855)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:KARLA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RBT-20-112855
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 SW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4132
Mailing Address - Country:US
Mailing Address - Phone:305-904-5738
Mailing Address - Fax:
Practice Address - Street 1:9010 SW 137TH AVE STE 239
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1408
Practice Address - Country:US
Practice Address - Phone:305-903-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-112855106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105743500Medicaid