Provider Demographics
NPI:1124866355
Name:REYES HERNANDEZ, KARINA YINETH
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:YINETH
Last Name:REYES HERNANDEZ
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 1:13785 SW 66TH ST APT C233
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2230
Mailing Address - Country:US
Mailing Address - Phone:305-889-8989
Mailing Address - Fax:
Practice Address - Street 1:13785 SW 66TH ST APT C233
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2230
Practice Address - Country:US
Practice Address - Phone:305-889-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-352241106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician