Healthcare Provider Details

I. General information

NPI: 1083436844
Provider Name (Legal Business Name): DENYS MARTINEZ REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 NW 183RD ST STE 108A
NORTH MIAMI BEACH FL
33169-4518
US

IV. Provider business mailing address

99 NW 183RD ST STE 108A
NORTH MIAMI BEACH FL
33169-4518
US

V. Phone/Fax

Practice location:
  • Phone: 305-816-6863
  • Fax: 305-816-6825
Mailing address:
  • Phone: 305-816-6863
  • Fax: 305-816-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: