Provider Demographics
NPI:1366861734
Name:REYES-CARDERO, JORGE (SURGICAL ASSITANT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:REYES-CARDERO
Suffix:
Gender:M
Credentials:SURGICAL ASSITANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 NW 11TH ST APT 25
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3600
Mailing Address - Country:US
Mailing Address - Phone:786-318-7097
Mailing Address - Fax:
Practice Address - Street 1:3661 S MIAMI AVE STE 708
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4214
Practice Address - Country:US
Practice Address - Phone:305-856-1002
Practice Address - Fax:305-856-0199
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13-428174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist