Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | ||
Y | 363L00000X | Nurse Practitioner | APRN11006681 | FL |
NPI | 1003325838 |
---|---|
Provider Name | Alexander Reyna Cisneros |
First Address | Miami, FL 33135-4243 |
Second Address | Miami, FL 33135-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2017 |
Last Update Date | 04/05/2021 |