Provider Demographics
NPI:1780636217
Name:REIMON, PEDRO CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:CARLOS
Last Name:REIMON
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 1:11921 SW 134TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4540
Mailing Address - Country:US
Mailing Address - Phone:786-444-4499
Mailing Address - Fax:
Practice Address - Street 1:13155 SW 42ND ST
Practice Address - Street 2:#106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3428
Practice Address - Country:US
Practice Address - Phone:305-220-1310
Practice Address - Fax:305-220-1323
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58770208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370439400Medicaid
FLF3507Medicare UPIN