Provider Demographics
NPI:1073132213
Name:ARCIS REYNALDO, RUBEN ALEJANDRO
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:ALEJANDRO
Last Name:ARCIS REYNALDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 W 37TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-8215
Mailing Address - Country:US
Mailing Address - Phone:305-417-9920
Mailing Address - Fax:
Practice Address - Street 1:823 W 37TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-8215
Practice Address - Country:US
Practice Address - Phone:305-417-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171W00000XOther Service ProvidersContractor