Healthcare Provider Details

I. General information

NPI: 1710378641
Provider Name (Legal Business Name): TATIANA S REY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15787 SW 72ND ST
MIAMI FL
33193
US

IV. Provider business mailing address

15787 SW 72ND ST
MIAMI FL
33193-5069
US

V. Phone/Fax

Practice location:
  • Phone: 305-505-3335
  • Fax:
Mailing address:
  • Phone: 305-505-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN21164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: