Provider Demographics
NPI:1700636685
Name:HERNANDEZ REYES, YISEL (RBT)
Entity Type:Individual
Prefix:MS
First Name:YISEL
Middle Name:
Last Name:HERNANDEZ REYES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14121 LAKE SARANAC AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3060
Mailing Address - Country:US
Mailing Address - Phone:305-587-6136
Mailing Address - Fax:
Practice Address - Street 1:14121 LAKE SARANAC AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-3060
Practice Address - Country:US
Practice Address - Phone:305-587-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-138488106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician