Provider Demographics
NPI:1912701541
Name:REYES DELGADO, DAIREN
Entity type:Individual
Prefix:
First Name:DAIREN
Middle Name:
Last Name:REYES DELGADO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NW 72ND AVE STE 1083
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3176
Mailing Address - Country:US
Mailing Address - Phone:786-490-6307
Mailing Address - Fax:
Practice Address - Street 1:7930 BAY POINTE DR APT B15
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5518
Practice Address - Country:US
Practice Address - Phone:813-313-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-421798106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician