Provider Demographics
NPI:1184936502
Name:ADELHEID C. REINOSO MD, PA
Entity type:Organization
Organization Name:ADELHEID C. REINOSO MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELHEID
Authorized Official - Middle Name:C
Authorized Official - Last Name:REINOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-322-7335
Mailing Address - Street 1:3700 WASHINTON STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8249
Mailing Address - Country:US
Mailing Address - Phone:954-322-7335
Mailing Address - Fax:954-322-7598
Practice Address - Street 1:3700 WASHINTON STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8249
Practice Address - Country:US
Practice Address - Phone:954-322-7335
Practice Address - Fax:954-322-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG70749Medicare UPIN