Healthcare Provider Details

I. General information

NPI: 1568923027
Provider Name (Legal Business Name): JENNY CAROLINA REATEGUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 N UNIVERSITY DR STE 101
CORAL SPRINGS FL
33067-4640
US

IV. Provider business mailing address

5441 N UNIVERSITY DR STE 101
CORAL SPRINGS FL
33067-4640
US

V. Phone/Fax

Practice location:
  • Phone: 954-803-9002
  • Fax: 954-933-2305
Mailing address:
  • Phone: 954-803-9002
  • Fax: 954-933-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME161727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: