Provider Demographics
NPI:1518735844
Name:REYES RINCON, JUSTIN ALEJANDRO
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ALEJANDRO
Last Name:REYES RINCON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13542 N FLORIDA AVE STE 213B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3200
Mailing Address - Country:US
Mailing Address - Phone:813-504-1149
Mailing Address - Fax:
Practice Address - Street 1:13542 N FLORIDA AVE STE 213B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3200
Practice Address - Country:US
Practice Address - Phone:813-504-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider