Healthcare Provider Details

I. General information

NPI: 1467220913
Provider Name (Legal Business Name): REINIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 W FAIRBANKS AVE
WINTER PARK FL
32789-4326
US

IV. Provider business mailing address

161 W FAIRBANKS AVE
WINTER PARK FL
32789-4326
US

V. Phone/Fax

Practice location:
  • Phone: 407-435-0859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: KRISTEL CALLE
Title or Position: MANAGER
Credential:
Phone: 407-435-0859