Healthcare Provider Details

I. General information

NPI: 1902632391
Provider Name (Legal Business Name): KATERINA DIANA REY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7867 N KENDALL DR
MIAMI FL
33156-7742
US

IV. Provider business mailing address

1700 NW NORTH RIVER DR APT 1004
MIAMI FL
33125-2352
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-1155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11035158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: