Provider Demographics
NPI:1154101616
Name:REYES, YASMIN SAN NICOLAS
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:SAN NICOLAS
Last Name:REYES
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 1:4235 HARVEST CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4123
Mailing Address - Country:US
Mailing Address - Phone:210-385-5743
Mailing Address - Fax:
Practice Address - Street 1:4235 HARVEST CIR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4123
Practice Address - Country:US
Practice Address - Phone:210-385-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist