Provider Demographics
NPI:1508907346
Name:MARIO E REYES MD PA
Entity Type:Organization
Organization Name:MARIO E REYES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-816-5956
Mailing Address - Street 1:19832 NW 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6206
Mailing Address - Country:US
Mailing Address - Phone:305-816-5956
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 72 AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3015
Practice Address - Country:US
Practice Address - Phone:305-898-5340
Practice Address - Fax:305-279-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH243Medicare PIN