Provider Demographics
NPI:1821399569
Name:REYES, JENNIFER ROSELLO (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROSELLO
Last Name:REYES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8485 SW 40 STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1000
Mailing Address - Country:US
Mailing Address - Phone:305-551-3412
Mailing Address - Fax:
Practice Address - Street 1:8485 SW 40TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3262
Practice Address - Country:US
Practice Address - Phone:305-551-3412
Practice Address - Fax:305-551-1945
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3591213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery