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General NPI Number Information
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NPI Number | 1295379444
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Entity Type | Individual
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Provider Name | CELIA REZNITSKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/31/2019
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 2630 NE 203RD ST STE 105
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City | MIAMI
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State | FL
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Zip | 33180-1903
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Country | US
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Telephone | 305-692-8998
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 NE 170TH ST
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City | MIAMI
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State | FL
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Zip | 33162-2633
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Country | US
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Telephone | 305-989-9367
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9112523
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License Number State | FL
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