Provider Demographics
NPI:1821585514
Name:REYES, CORALIS IVETTE
Entity Type:Individual
Prefix:
First Name:CORALIS
Middle Name:IVETTE
Last Name:REYES
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 1:2222 COLONIAL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-5309
Mailing Address - Country:US
Mailing Address - Phone:772-489-4726
Mailing Address - Fax:772-489-0423
Practice Address - Street 1:408 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-4129
Practice Address - Country:US
Practice Address - Phone:863-824-0300
Practice Address - Fax:863-824-0024
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical