Provider Demographics
NPI:1861659708
Name:REYES, ALEXANDRIA R (DO)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:R
Last Name:REYES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W KENNEDY BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1940
Mailing Address - Country:US
Mailing Address - Phone:813-773-6627
Mailing Address - Fax:813-443-6001
Practice Address - Street 1:3216 W AZEELE ST STE 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3018
Practice Address - Country:US
Practice Address - Phone:813-773-6627
Practice Address - Fax:813-443-6001
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12517207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010868000Medicaid
FL010868000Medicaid