Provider Demographics
NPI:1073959003
Name:REYES, IRISH M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:IRISH
Middle Name:M
Last Name:REYES
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6278 N FEDERAL HWY
Mailing Address - Street 2:# 331
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1916
Mailing Address - Country:US
Mailing Address - Phone:305-331-6014
Mailing Address - Fax:954-942-2265
Practice Address - Street 1:1600 E ATLANTIC BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6768
Practice Address - Country:US
Practice Address - Phone:305-441-6909
Practice Address - Fax:954-942-2265
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9107052363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical