Provider Demographics
NPI:1720666548
Name:REYES ORTIZ, EDWARD
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:REYES ORTIZ
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 1:252 RAPSCALLION CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8988
Mailing Address - Country:US
Mailing Address - Phone:787-638-1700
Mailing Address - Fax:
Practice Address - Street 1:252 RAPSCALLION CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8988
Practice Address - Country:US
Practice Address - Phone:787-638-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst