Provider Demographics
NPI:1114983707
Name:DACO, REYNALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:
Last Name:DACO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W KALEY ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2931
Mailing Address - Country:US
Mailing Address - Phone:407-843-3637
Mailing Address - Fax:
Practice Address - Street 1:60 W KALEY ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2931
Practice Address - Country:US
Practice Address - Phone:407-843-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55503Medicare UPIN