MEDICARE: MANUELA SEMINO REYES SR.

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	106E00000X	Assistant Behavior Analyst	0-18-9048	FL
2	2355S0801X	Speech-Language Assistant		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972952075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUELA SEMINO REYES SR.

Provider Business Mailing Address
First Line	:	6529 W 3RD AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6717
Country	:	US
Telephone Number	:	786-447-1944
Fax Number	:

Provider Business Practice Location Address
First Line	:	6529 W 3RD AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6717
Country	:	US
Telephone Number	:	786-447-1944
Fax Number	:

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

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	01/31/2021

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