MEDICARE: DR. NEMENCIO REYES RONQUILLO JR. MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	TP991	KY
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME143106	FL

General Provider Information

NPI Number	:	1427360890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEMENCIO REYES RONQUILLO JR. MD

Provider Business Mailing Address
First Line	:	16115 SW 117TH AVENUE
Second Line	:	SUITE 15
City	:	MIAMI
State	:	FL
Zip	:	33177
Country	:	US
Telephone Number	:	305-539-0919
Fax Number	:	786-310-6020

Provider Business Practice Location Address
First Line	:	1475 NW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1002
Country	:	US
Telephone Number	:	305-585-5886
Fax Number	:

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

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	06/02/2026

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