Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | OS8415 | FL |
NPI | 1164453734 |
---|---|
Provider Name | Dr. Ivonne M Reynolds |
First Address | Margate, FL 33063-5715 |
Second Address | Margate, FL 33063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 25/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
261981400 | (05) | FL |
58924Y | (02) | FL |
H42108 | (02) | FL |