Provider Demographics
NPI:1629612809
Name:DELGADO REYES, HERIBERTO (RBT)
Entity Type:Individual
Prefix:MR
First Name:HERIBERTO
Middle Name:
Last Name:DELGADO REYES
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 NW 199TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1509
Mailing Address - Country:US
Mailing Address - Phone:786-442-0297
Mailing Address - Fax:
Practice Address - Street 1:4610 NW 199TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1509
Practice Address - Country:US
Practice Address - Phone:786-442-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-70075106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician