Healthcare Provider Details

I. General information

NPI: 1396672556
Provider Name (Legal Business Name): REYNIEL SANTANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 W 9TH LN
HIALEAH FL
33010-1228
US

IV. Provider business mailing address

2656 W 9TH LN
HIALEAH FL
33010-1228
US

V. Phone/Fax

Practice location:
  • Phone: 305-815-3411
  • Fax:
Mailing address:
  • Phone: 305-815-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-508123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: