Provider Demographics
NPI:1871132738
Name:REYES, ANTONIO DE JESUS
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:DE JESUS
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8165 NW 192ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5204
Mailing Address - Country:US
Mailing Address - Phone:786-468-9744
Mailing Address - Fax:
Practice Address - Street 1:8165 NW 192ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5204
Practice Address - Country:US
Practice Address - Phone:786-468-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-24
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821637018OtherNON-EMERGENCY MEDICAL TRANSPORTATION
FL1871132738Medicaid
FL5892372OtherBUSSINESS PARTNER