MEDICARE: ESTELI REYES GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT24369790	FL

General Provider Information

NPI Number	:	1023844230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTELI REYES GONZALEZ

Provider Business Mailing Address
First Line	:	3672 SW 17TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-1769
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3672 SW 17TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-1769
Country	:	US
Telephone Number	:	786-760-7987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	09/16/2024

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