Healthcare Provider Details

I. General information

NPI: 1245083963
Provider Name (Legal Business Name): REINA CHAVEZ LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W IRLO BRONSON MEMORIAL HWY LOT 550
KISSIMMEE FL
34746-4792
US

IV. Provider business mailing address

5300 W IRLO BRONSON MEMORIAL HWY LOT 550
KISSIMMEE FL
34746-4792
US

V. Phone/Fax

Practice location:
  • Phone: 407-917-0540
  • Fax: 407-610-6866
Mailing address:
  • Phone: 407-917-0540
  • Fax: 407-610-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberTMW21
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: