Healthcare Provider Details

I. General information

NPI: 1639669492
Provider Name (Legal Business Name): BELKIS REYES IMBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6690 MIRAMAR PKWY
MIRAMAR FL
33023-3882
US

IV. Provider business mailing address

6690 MIRAMAR PKWY
MIRAMAR FL
33023-3882
US

V. Phone/Fax

Practice location:
  • Phone: 786-678-9255
  • Fax:
Mailing address:
  • Phone: 786-678-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-21-12413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: