Healthcare Provider Details

I. General information

NPI: 1962234609
Provider Name (Legal Business Name): MASSIEL REYNA CARABALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13416 SW 59TH LN
MIAMI FL
33183-5119
US

IV. Provider business mailing address

13416 SW 59TH LN
MIAMI FL
33183-5119
US

V. Phone/Fax

Practice location:
  • Phone: 786-239-9776
  • Fax:
Mailing address:
  • Phone: 786-239-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13367
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: