Provider Demographics
NPI:1427597863
Name:REITER, PALOMA NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:PALOMA
Middle Name:NICOLE
Last Name:REITER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PALOMA
Other - Middle Name:NICOLE
Other - Last Name:REITER AYALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1447 MEDICAL PARK BLVD.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-798-3494
Mailing Address - Fax:
Practice Address - Street 1:1447 MEDICAL PARK BLVD.
Practice Address - Street 2:STE 107
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3164
Practice Address - Country:US
Practice Address - Phone:561-798-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15515207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology