Provider Demographics
NPI:1952441651
Name:REYES, CIRO R (MD)
Entity Type:Individual
Prefix:
First Name:CIRO
Middle Name:R
Last Name:REYES
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 1:13055 SW 42ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3410
Mailing Address - Country:US
Mailing Address - Phone:786-334-5839
Mailing Address - Fax:786-334-5843
Practice Address - Street 1:13055 SW 42ND ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3410
Practice Address - Country:US
Practice Address - Phone:786-334-5839
Practice Address - Fax:786-334-5843
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89828208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259630000Medicaid
FLU3596Medicare PIN
FLI19166Medicare UPIN