Healthcare Provider Details

I. General information

NPI: 1194661181
Provider Name (Legal Business Name): RAUL R DIAZ REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E MICHIGAN ST STE B
ORLANDO FL
32806-4815
US

IV. Provider business mailing address

8813 KENSINGTON CT
KISSIMMEE FL
34747-1603
US

V. Phone/Fax

Practice location:
  • Phone: 407-488-6898
  • Fax:
Mailing address:
  • Phone: 786-609-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-528547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: