Healthcare Provider Details

I. General information

NPI: 1063865681
Provider Name (Legal Business Name): CAMERON REINERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 PINEBROOK RD
VENICE FL
34285-6421
US

IV. Provider business mailing address

515 ROUSSEAU DR
NOKOMIS FL
34275-4228
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-6733
  • Fax:
Mailing address:
  • Phone: 518-526-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberOTA15249
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: