Healthcare Provider Details

I. General information

NPI: 1134150477
Provider Name (Legal Business Name): JESSE REEVES-GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 SW 87TH CT STE 206
MIAMI FL
33176-2223
US

IV. Provider business mailing address

3200 SW 60TH CT SUITE 204
MIAMI FL
33155-4000
US

V. Phone/Fax

Practice location:
  • Phone: 786-888-2480
  • Fax: 305-274-1282
Mailing address:
  • Phone: 305-661-6110
  • Fax: 305-662-5882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME0051318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: