Provider Demographics
NPI:1821112020
Name:JULIO FERNANDEZ-BOMBINO & REYNALDO MOLINA
Entity Type:Organization
Organization Name:JULIO FERNANDEZ-BOMBINO & REYNALDO MOLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-557-8300
Mailing Address - Street 1:7100 W 20TH AVE
Mailing Address - Street 2:602
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1897
Mailing Address - Country:US
Mailing Address - Phone:305-557-8300
Mailing Address - Fax:305-557-1410
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:602
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-557-8300
Practice Address - Fax:305-557-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77786Medicare PIN