Provider Demographics
NPI:1619468519
Name:REINO AGOSTO, TATIANA HILDA
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:HILDA
Last Name:REINO AGOSTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CALLE 22
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5206
Mailing Address - Country:US
Mailing Address - Phone:787-413-1296
Mailing Address - Fax:787-413-1296
Practice Address - Street 1:1199 W FLAGLER ST STE 7
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1055
Practice Address - Country:US
Practice Address - Phone:305-324-5072
Practice Address - Fax:305-403-2981
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-25258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist