Active NPI
Luis Jesus Requena Hernandez
- Behavior Technician
- Brandon, FL
National Provider Identifier
1174197669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1305 Zellwood Dr
Brandon, FL 33511-4839 - Phone
- (813) 330-6832
- NPI assigned
- May 18, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
1305 Zellwood Dr
Brandon, FL 33511-4839
Mailing address
305 Palm Key Cir Apt 206
Brandon, FL 33511-4672
Phone (813) 330-6832
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | https://secure.virtru.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621382400000",
"number": "1174197669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 PALM KEY CIR APT 206",
"city": "BRANDON",
"state": "FL",
"postal_code": "335114672",
"telephone_number": "813-330-6832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 ZELLWOOD DR",
"city": "BRANDON",
"state": "FL",
"postal_code": "335114839",
"telephone_number": "813-330-6832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REQUENA HERNANDEZ",
"first_name": "LUIS",
"middle_name": "JESUS",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-18",
"last_updated": "2021-05-19",
"certification_date": "2021-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "https://secure.virtru.com",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "305 Palm Key Cir Apt 206",
"city": "Brandon",
"state": "FL",
"country_code": "US",
"postal_code": "335114672",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Brandon, FL
- Rendon Support Services, Inc.
- Rendon Support Services, Inc.
- Renewed Integrative Wellness LLC
- Thomas Renter, CRNA
- Republic Pharmacy
- Resilience Rehab & Educational Services LLC
- Restorative Counseling Center, LLC
- Restore Therapy Services of Florida LLC
- Restoring All People Support Center LLC
- Katherine Reyer, APRN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.