Individual
LYDIA M JORGE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1611 NW 12TH AVE, BOX 016960, MIAMI, FL 33136-1005
(305) 585-8256
(305) 243-8470
Mailing address
1611 NW 12TH AVE, BOX 016960, MIAMI, FL 33136-1005
(305) 585-8256
(305) 243-8470
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME96171
FL
207LP3000X
Pediatric Anesthesiology Physician
ME96171
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2803381-00
—
FL
Enumeration date
11/14/2007
Last updated
08/13/2015
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