Provider Demographics
NPI:1780991935
Name:REYES, PRISCILLA
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W FLAGLER ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1806
Mailing Address - Country:US
Mailing Address - Phone:305-576-1000
Mailing Address - Fax:305-576-4097
Practice Address - Street 1:28 W FLAGLER ST
Practice Address - Street 2:SUITE 700
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1806
Practice Address - Country:US
Practice Address - Phone:305-576-1000
Practice Address - Fax:305-576-4097
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001998100Medicaid