Provider Demographics
NPI:1366503583
Name:LAJARA, REYNA ISABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:REYNA
Middle Name:ISABEL
Last Name:LAJARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REYNA
Other - Middle Name:ISABEL
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2600 S DOUGLAS RD STE 308
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6134
Mailing Address - Country:US
Mailing Address - Phone:305-913-9441
Mailing Address - Fax:305-442-1198
Practice Address - Street 1:127 RIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6401
Practice Address - Country:US
Practice Address - Phone:863-421-7400
Practice Address - Fax:863-421-7448
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN291208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice