Provider Demographics
NPI:1780068809
Name:GONZALEZ REINA, ELIESER
Entity type:Individual
Prefix:
First Name:ELIESER
Middle Name:
Last Name:GONZALEZ REINA
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 1:16722 SW 78TH CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3788
Mailing Address - Country:US
Mailing Address - Phone:787-628-3848
Mailing Address - Fax:
Practice Address - Street 1:16722 SW 78TH CT
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-3788
Practice Address - Country:US
Practice Address - Phone:787-628-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31590R207Q00000X
FLME129357207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine