Provider Demographics
NPI:1548803414
Name:SARMIENTO VIDAL, REINA KARINA (RBT)
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:KARINA
Last Name:SARMIENTO VIDAL
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 1:433 S ROYAL POINCIANA BLVD APT 401
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7274
Mailing Address - Country:US
Mailing Address - Phone:786-316-5757
Mailing Address - Fax:
Practice Address - Street 1:433 S ROYAL POINCIANA BLVD APT 401
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7274
Practice Address - Country:US
Practice Address - Phone:786-316-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician