Provider Demographics
NPI:1962971556
Name:FERNANDEZ, REY H
Entity type:Individual
Prefix:
First Name:REY
Middle Name:H
Last Name:FERNANDEZ
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 1:5290 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1165
Mailing Address - Country:US
Mailing Address - Phone:201-744-6630
Mailing Address - Fax:
Practice Address - Street 1:5290 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1165
Practice Address - Country:US
Practice Address - Phone:201-744-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-25-82902103K00000X
FL0-22-13861106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty