Healthcare Provider Details

I. General information

NPI: 1972952075
Provider Name (Legal Business Name): MANUELA SEMINO REYES SR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 01/31/2021
Certification Date: 01/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6529 W 3RD AVE
HIALEAH FL
33012-6717
US

IV. Provider business mailing address

6529 W 3RD AVE
HIALEAH FL
33012-6717
US

V. Phone/Fax

Practice location:
  • Phone: 786-447-1944
  • Fax:
Mailing address:
  • Phone: 786-447-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-18-9048
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: