Provider Demographics
NPI:1841206000
Name:CARVAJAL, REINALDO (MD)
Entity Type:Individual
Prefix:
First Name:REINALDO
Middle Name:
Last Name:CARVAJAL
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 1:431 NW 199TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3351
Mailing Address - Country:US
Mailing Address - Phone:305-827-3684
Mailing Address - Fax:954-430-0861
Practice Address - Street 1:431 NW 199TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3351
Practice Address - Country:US
Practice Address - Phone:305-827-3684
Practice Address - Fax:954-430-0861
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056797300Medicaid
FL14326Medicare ID - Type Unspecified