Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | ME108744 | FL |
NPI | 1265625701 |
---|---|
Provider Name | Enme G Corrales Reyes |
First Address | Miami, FL 33155-4071 |
Second Address | Weston, FL 33331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2007 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003721000 | (05) | FL |