Healthcare Provider Details

I. General information

NPI: 1730968645
Provider Name (Legal Business Name): BENJAMIN PAUL R DELOS REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 TABOR AVE APT 7
FAIRFIELD CA
94533-3294
US

IV. Provider business mailing address

300 AMERICAN CANYON RD APT H
AMERICAN CANYON CA
94503-1216
US

V. Phone/Fax

Practice location:
  • Phone: 845-300-0663
  • Fax:
Mailing address:
  • Phone: 845-300-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-249545
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-16801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: