Provider Demographics
NPI:1013583111
Name:TUDURI REYES, KIARA (RBT)
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:
Last Name:TUDURI REYES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15251 SW 23RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5700
Mailing Address - Country:US
Mailing Address - Phone:305-227-3093
Mailing Address - Fax:786-279-0915
Practice Address - Street 1:12805 SW 76TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4204
Practice Address - Country:US
Practice Address - Phone:859-618-9599
Practice Address - Fax:786-279-0915
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-159943106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician