Healthcare Provider Details

I. General information

NPI: 1972322949
Provider Name (Legal Business Name): MARVELIA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 SW 56TH ST STE 12
MIAMI FL
33165-7161
US

IV. Provider business mailing address

333 W 37TH ST
HIALEAH FL
33012-4325
US

V. Phone/Fax

Practice location:
  • Phone: 407-602-7442
  • Fax: 786-631-4483
Mailing address:
  • Phone: 786-574-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-382590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: