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General NPI Number Information
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NPI Number | 1154282572
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Entity Type | Individual
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Provider Name | LUIS GOMEZ REYES
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Gender | Male
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 566 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-5108
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Country | US
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Telephone | 772-202-0173
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Fax |
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Provider Business Mailing Address
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Address Line | 455 SW KESTOR DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-5520
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-485980
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License Number State | FL
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