Provider Demographics
NPI:1962579458
Name:REYES, JOSE RAUL (AP ,)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAUL
Last Name:REYES
Suffix:
Gender:M
Credentials:AP ,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 WASHINGTON AVE
Mailing Address - Street 2:APT. #307
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6660
Mailing Address - Country:US
Mailing Address - Phone:305-310-4980
Mailing Address - Fax:
Practice Address - Street 1:2445 NW 97TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2307
Practice Address - Country:US
Practice Address - Phone:305-310-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2288171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist