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General NPI Number Information
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NPI Number | 1821585514
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Entity Type | Individual
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Provider Name | CORALIS IVETTE REYES
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Gender | Female
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 408 NW 3RD ST
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City | OKEECHOBEE
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State | FL
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Zip | 34972-4129
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Country | US
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Telephone | 863-824-0300
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Fax | 863-824-0024
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Provider Business Mailing Address
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Address Line | 2222 COLONIAL RD STE 100
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City | FORT PIERCE
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State | FL
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Zip | 34950-5309
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Country | US
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Telephone | 772-489-4726
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Fax | 772-489-0423
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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