Healthcare Provider Details

I. General information

NPI: 1255861142
Provider Name (Legal Business Name): GABRIELA REYES GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 SE PORT ST LUCIE BLVD
PORT ST LUCIE FL
34984-5108
US

IV. Provider business mailing address

566 SE PORT ST LUCIE BLVD
PORT ST LUCIE FL
34984-5108
US

V. Phone/Fax

Practice location:
  • Phone: 772-202-0173
  • Fax: 772-209-7631
Mailing address:
  • Phone: 771-202-0173
  • Fax: 771-209-7631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-63674
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: