Provider Demographics
NPI:1457055295
Name:SANTIESTEBAN, RENY ANTHONY SR
Entity type:Individual
Prefix:MR
First Name:RENY
Middle Name:ANTHONY
Last Name:SANTIESTEBAN
Suffix:SR
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 1:440 E 23RD ST APT 1402
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3940
Mailing Address - Country:US
Mailing Address - Phone:786-339-4882
Mailing Address - Fax:
Practice Address - Street 1:6625 MIAMI LAKES DR STE 338
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2705
Practice Address - Country:US
Practice Address - Phone:305-777-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-259368106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician