Provider Demographics
NPI:1033798970
Name:IZQUIERDO HERNANDEZ, MARICELA
Entity type:Individual
Prefix:
First Name:MARICELA
Middle Name:
Last Name:IZQUIERDO HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NW 20TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993
Mailing Address - Country:US
Mailing Address - Phone:786-259-3594
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 20TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993
Practice Address - Country:US
Practice Address - Phone:786-259-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-125228106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician