Provider Demographics
NPI:1063642817
Name:RONALD EMILIO REYNA, M.D., PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:RONALD EMILIO REYNA, M.D., PROFESSIONAL ASSOCIATION
Other - Org Name:REYNA PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EMILIO
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-856-8565
Mailing Address - Street 1:3850 BIRD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1521
Mailing Address - Country:US
Mailing Address - Phone:305-856-8565
Mailing Address - Fax:
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE 609
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-856-8565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 104025208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty