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General NPI Number Information
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NPI Number | 1659297604
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Entity Type | Individual
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Provider Name | JORGE DANIEL CORRO REYES
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Gender | Male
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 5750 W THUNDERBIRD RD BLDG B
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City | GLENDALE
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State | AZ
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Zip | 85306-4660
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Country | US
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Telephone | 602-536-6123
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Fax |
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Provider Business Mailing Address
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Address Line | 945 N CENTRAL AVE
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City | WOODMERE
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State | NY
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Zip | 11598-1604
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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 |
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License Number State |
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