Provider Demographics
NPI:1609630268
Name:REYES DE LA CRUZ, YEFRI
Entity Type:Individual
Prefix:
First Name:YEFRI
Middle Name:
Last Name:REYES DE LA CRUZ
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 1:5324 BRISTO ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-6601
Mailing Address - Country:US
Mailing Address - Phone:239-810-3206
Mailing Address - Fax:
Practice Address - Street 1:5324 BRISTO ST
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-6601
Practice Address - Country:US
Practice Address - Phone:239-810-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-321728106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician