Provider Demographics
NPI:1619776622
Name:REYES-GUILLEN, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:REYES-GUILLEN
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 1:9906 SAGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6689
Mailing Address - Country:US
Mailing Address - Phone:813-512-9039
Mailing Address - Fax:
Practice Address - Street 1:5706 N HESPERIDES ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5418
Practice Address - Country:US
Practice Address - Phone:813-924-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-413737106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst