Provider Demographics
NPI:1023170008
Name:REINOSA, ODILIE AMBER (PA-C)
Entity type:Individual
Prefix:MS
First Name:ODILIE
Middle Name:AMBER
Last Name:REINOSA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SW 129TH AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1716
Mailing Address - Country:US
Mailing Address - Phone:754-422-6295
Mailing Address - Fax:
Practice Address - Street 1:1 SW 129TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1716
Practice Address - Country:US
Practice Address - Phone:954-430-9898
Practice Address - Fax:954-430-9677
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant