=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881079531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARY B. REYES PH.D. PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2015
-----------------------------------------------------
Last Update Date | 07/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 724 NW 19TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-325-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9265 SW 63RD ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-596-6577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. NORALIS FRANCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-919-8099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | PY7474
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------