Healthcare Provider Details

I. General information

NPI: 1871625848
Provider Name (Legal Business Name): REYNEL LAVANDERA SR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 NW 167TH ST
OPA LOCKA FL
33054-6232
US

IV. Provider business mailing address

3804 NW 167TH ST
OPA LOCKA FL
33054-6232
US

V. Phone/Fax

Practice location:
  • Phone: 305-975-4182
  • Fax:
Mailing address:
  • Phone: 305-975-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN3027322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: