Provider Demographics
NPI:1003651357
Name:MACIAS, REYNA ELIZABETH
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:ELIZABETH
Last Name:MACIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 SW 40TH ST APT 420
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3883
Mailing Address - Country:US
Mailing Address - Phone:925-321-5226
Mailing Address - Fax:
Practice Address - Street 1:7004 SW 40TH ST APT 420
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3883
Practice Address - Country:US
Practice Address - Phone:925-321-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer