Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 015546 | ME |
Y | 2080P0202X | Pediatric Cardiologist | ME86455 | FL |
NPI | 1255373049 |
---|---|
Provider Name | Aurelio Reyes |
First Address | Apopka, FL 32703-4947 |
Second Address | Apopka, FL 32703-4947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 21/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
317050099 | (05) | ME |
G77163 | (02) |