Provider Demographics
NPI:1669736922
Name:BANOS, REINALDO (MD-SURG-ASSIST)
Entity type:Individual
Prefix:
First Name:REINALDO
Middle Name:
Last Name:BANOS
Suffix:
Gender:M
Credentials:MD-SURG-ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14401 SW 108TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6642
Mailing Address - Country:US
Mailing Address - Phone:407-718-6028
Mailing Address - Fax:
Practice Address - Street 1:14401 SW 108TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6642
Practice Address - Country:US
Practice Address - Phone:407-718-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLABSA 11-252246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist