Provider Demographics
NPI:1083443980
Name:CHONG REYES, JAVIER ALEJANDRO
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:ALEJANDRO
Last Name:CHONG REYES
Suffix:
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 1:923 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-5362
Mailing Address - Country:US
Mailing Address - Phone:239-328-4723
Mailing Address - Fax:
Practice Address - Street 1:923 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-5362
Practice Address - Country:US
Practice Address - Phone:239-328-4723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-362655106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician