Provider Demographics
NPI:1003922444
Name:REYES, EDUARDO M (POR)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:M
Last Name:REYES
Suffix:
Gender:M
Credentials:POR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10351 SW 60TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2825
Mailing Address - Country:US
Mailing Address - Phone:305-552-8400
Mailing Address - Fax:305-552-6398
Practice Address - Street 1:8485 SW 40TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3244
Practice Address - Country:US
Practice Address - Phone:305-552-8400
Practice Address - Fax:305-552-6398
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR66222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist