Provider Demographics
NPI:1942051743
Name:JUSTINA PALACIOS REYES PA
Entity Type:Organization
Organization Name:JUSTINA PALACIOS REYES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIOS REYES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-250-7894
Mailing Address - Street 1:6963 W 5TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4944
Mailing Address - Country:US
Mailing Address - Phone:786-250-7894
Mailing Address - Fax:
Practice Address - Street 1:6963 W 5TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4944
Practice Address - Country:US
Practice Address - Phone:786-250-7894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty