Provider Demographics
NPI:1093539009
Name:ESTOPINAN GOMEZ, REYNIER
Entity type:Individual
Prefix:
First Name:REYNIER
Middle Name:
Last Name:ESTOPINAN GOMEZ
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 1:13787 SW 66TH ST APT D257
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1838
Mailing Address - Country:US
Mailing Address - Phone:305-300-6603
Mailing Address - Fax:
Practice Address - Street 1:13787 SW 66TH ST APT D257
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1838
Practice Address - Country:US
Practice Address - Phone:305-300-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-390622106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician