Provider Demographics
NPI:1154311397
Name:REINOSO, JUAN E (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:E
Last Name:REINOSO
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 1:2400 N. ORANGE BLOSSOM TRAIL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4198
Mailing Address - Country:US
Mailing Address - Phone:407-846-7200
Mailing Address - Fax:407-846-3989
Practice Address - Street 1:2400 N. ORANGE BLOSSOM TRAIL
Practice Address - Street 2:SUITE 300
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4198
Practice Address - Country:US
Practice Address - Phone:407-846-7200
Practice Address - Fax:407-846-3989
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74163207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257077700Medicaid
BR6406789Medicare UPIN
FL47251YMedicare ID - Type Unspecified