Provider Demographics
NPI:1518748631
Name:REYES AGUILERA, MAIKELIS
Entity Type:Individual
Prefix:
First Name:MAIKELIS
Middle Name:
Last Name:REYES AGUILERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6560
Mailing Address - Country:US
Mailing Address - Phone:561-729-5807
Mailing Address - Fax:
Practice Address - Street 1:1823 WOODHAVEN DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-6560
Practice Address - Country:US
Practice Address - Phone:561-729-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-295782106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician