Provider Demographics
NPI:1053887281
Name:REGUEIRA JACOMINO, IRIS
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:REGUEIRA JACOMINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 SW 109TH CT APT D110
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3319
Mailing Address - Country:US
Mailing Address - Phone:786-709-5444
Mailing Address - Fax:
Practice Address - Street 1:9260 HAMMOCKS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1584
Practice Address - Country:US
Practice Address - Phone:786-353-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst