Provider Demographics
NPI:1861262362
Name:FERNANDEZ CAMALLERE, GLENIAR
Entity type:Individual
Prefix:MRS
First Name:GLENIAR
Middle Name:
Last Name:FERNANDEZ CAMALLERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 HOLLY BRANCH DR APT 912
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7117
Mailing Address - Country:US
Mailing Address - Phone:407-984-8306
Mailing Address - Fax:
Practice Address - Street 1:730 SAND LAKE RD STE 128
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7747
Practice Address - Country:US
Practice Address - Phone:407-214-5539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-319890106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician