Provider Demographics
NPI:1710279112
Name:REYES, OMAR
Entity Type:Individual
Prefix:MR
First Name:OMAR
Middle Name:
Last Name:REYES
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 1:717 PONCE DE LEON BLVD
Mailing Address - Street 2:202
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 PONCE DE LEON BLVD
Practice Address - Street 2:202
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2070
Practice Address - Country:US
Practice Address - Phone:305-967-8321
Practice Address - Fax:305-967-8714
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center