Provider Demographics
NPI:1548995780
Name:REYES, GARIBALDI
Entity type:Individual
Prefix:MR
First Name:GARIBALDI
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GARIBALDI
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GARIBALDI REYES
Mailing Address - Street 1:1090 CHATHAM BREAK ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6859
Mailing Address - Country:US
Mailing Address - Phone:973-262-1730
Mailing Address - Fax:
Practice Address - Street 1:1090 CHATHAM BREAK ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6859
Practice Address - Country:US
Practice Address - Phone:973-262-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor