Healthcare Provider Details

I. General information

NPI: 1528119872
Provider Name (Legal Business Name): GUSTAVO J REY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST
MIAMI FL
33136-2137
US

IV. Provider business mailing address

1150 NW 14TH ST
MIAMI FL
33136-2137
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3100
  • Fax: 305-243-8108
Mailing address:
  • Phone: 305-243-3100
  • Fax: 305-243-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY0004712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: