Provider Demographics
NPI:1861579344
Name:REYNA, RONALD EMILIO (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EMILIO
Last Name:REYNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3850 BIRD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1521
Mailing Address - Country:US
Mailing Address - Phone:305-856-8565
Mailing Address - Fax:305-856-8563
Practice Address - Street 1:3850 BIRD RD STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-1521
Practice Address - Country:US
Practice Address - Phone:305-856-8565
Practice Address - Fax:305-856-8563
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL26209208600000X
FLME 104025208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery