Provider Demographics
NPI:1053833301
Name:REYES, FERNANDO RAMON
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:RAMON
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 W 44TH PL APT 428
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7808
Mailing Address - Country:US
Mailing Address - Phone:786-426-2520
Mailing Address - Fax:
Practice Address - Street 1:1555 W 44TH PL APT 248
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7121
Practice Address - Country:US
Practice Address - Phone:786-426-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst