Provider Demographics
NPI:1336928472
Name:ARIZA, REIDY MIGUEL (APRN)
Entity Type:Individual
Prefix:
First Name:REIDY
Middle Name:MIGUEL
Last Name:ARIZA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19645 LENAIRE DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8548
Mailing Address - Country:US
Mailing Address - Phone:786-448-9832
Mailing Address - Fax:
Practice Address - Street 1:19645 LENAIRE DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8548
Practice Address - Country:US
Practice Address - Phone:786-448-9832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026127207Q00000X
FL11026127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine