Healthcare Provider Details

I. General information

NPI: 1780636217
Provider Name (Legal Business Name): PEDRO CARLOS REIMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13155 SW 42ND ST #106
MIAMI FL
33175-3428
US

IV. Provider business mailing address

11921 SW 134TH CT
MIAMI FL
33186-4540
US

V. Phone/Fax

Practice location:
  • Phone: 305-220-1310
  • Fax: 305-220-1323
Mailing address:
  • Phone: 786-444-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME58770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: