MEDICARE: ALEXANDER REYNA CISNEROS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	363L00000X	Nurse Practitioner	APRN11006681	FL

General Provider Information

NPI Number	:	1003325838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER REYNA CISNEROS

Provider Business Mailing Address
First Line	:	1100 SW 36TH CT APT 1
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-4243
Country	:	US
Telephone Number	:	178-637-9604
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SW 36TH CT APT 1
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-4243
Country	:	US
Telephone Number	:	178-637-9604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	05/04/2021

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