MEDICARE: DR. DAISY M FRAU-REYNA M.D.

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	2085R0202X	Diagnostic Radiology Physician	ME66889	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	32611	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710980990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAISY M FRAU-REYNA M.D.

Provider Business Mailing Address
First Line	:	500 N HIATUS RD STE 200
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-5213
Country	:	US
Telephone Number	:	954-437-4800
Fax Number	:	954-437-6628

Provider Business Practice Location Address
First Line	:	MEMORIAL HOSPITAL WEST
Second Line	:	703 NORTH FLAMINGO ROAD
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026
Country	:	US
Telephone Number	:	954-448-7135
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/21/2022

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