=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063642817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD EMILIO REYNA, M.D., PROFESSIONAL ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2009
-----------------------------------------------------
Last Update Date | 09/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3661 S MIAMI AVE SUITE 609
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33133-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-856-8565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3850 BIRD RD STE 102
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-1521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-856-8565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. RONALD EMILIO REYNA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-856-8565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | ME 104025
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------