Healthcare Provider Details

I. General information

NPI: 1417799388
Provider Name (Legal Business Name): MARIELA HERNANDEZ REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ROMANO AVE
ORLANDO FL
32807-1568
US

IV. Provider business mailing address

910 ROMANO AVE
ORLANDO FL
32807-1568
US

V. Phone/Fax

Practice location:
  • Phone: 407-405-3973
  • Fax: 407-405-3973
Mailing address:
  • Phone: 407-405-3973
  • Fax: 407-405-3973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: