Provider Demographics
NPI:1801764113
Name:REYES RODRIGUEZ, CARLA GUADALUPE (106S00000X)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:GUADALUPE
Last Name:REYES RODRIGUEZ
Suffix:
Gender:F
Credentials:106S00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 NE 51ST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2428
Mailing Address - Country:US
Mailing Address - Phone:954-554-0318
Mailing Address - Fax:
Practice Address - Street 1:471 NE 51ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2428
Practice Address - Country:US
Practice Address - Phone:954-554-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty