Provider Demographics
NPI:1578582664
Name:REYNA, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:REYNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE 609
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-856-6167
Mailing Address - Fax:305-859-7269
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE 609
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-856-6167
Practice Address - Fax:305-859-7269
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26775208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0594881 00Medicaid
FL0594881 00Medicaid
FL92532Medicare PIN