Provider Demographics
NPI:1528119872
Name:REY, GUSTAVO J (PHD)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:J
Last Name:REY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2137
Mailing Address - Country:US
Mailing Address - Phone:305-243-3100
Mailing Address - Fax:305-243-8108
Practice Address - Street 1:1150 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2137
Practice Address - Country:US
Practice Address - Phone:305-243-3100
Practice Address - Fax:305-243-8108
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004712103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist