Provider Demographics
NPI:1023689411
Name:FERNANDEZ HERRERA, RONALDO EMILIO (RBT)
Entity type:Individual
Prefix:
First Name:RONALDO
Middle Name:EMILIO
Last Name:FERNANDEZ HERRERA
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 1:10725 SW 166TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2974
Mailing Address - Country:US
Mailing Address - Phone:786-757-1337
Mailing Address - Fax:
Practice Address - Street 1:10725 SW 166TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-2974
Practice Address - Country:US
Practice Address - Phone:786-757-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-172366106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician