Provider Demographics
NPI:1295134591
Name:SIFONTES MEJIAS, RENE
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:SIFONTES MEJIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8871 FONTAINEBLEAU BLVD APT 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4447
Mailing Address - Country:US
Mailing Address - Phone:786-317-7495
Mailing Address - Fax:
Practice Address - Street 1:25001 SW 127TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5834
Practice Address - Country:US
Practice Address - Phone:786-339-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily