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4055 Nw 97th Ave Ste 100 Doral FL 33178-2911 | |
| (786) 452-1067 | |
| (786) 472-1280 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4055 Nw 97th Ave Ste 100, Doral, Florida |
| Authorized Official Name and Position | Silvana G Gonzalez Reiley (MD MANAGER) |
| Authorized Official Contact | 7864521067 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
9821 Nw 88th Ter Doral FL 33178-2495 Ph: (786) 899-0391 | 4055 Nw 97th Ave Ste 100 Doral FL 33178-2911 Ph: (786) 452-1067 |
| NPI Number | 1205233558 |
|---|---|
| Provider Enumeration Date | 12/02/2014 |
| Last Update Date | 10/27/2021 |
| Certification Date | 10/27/2021 |
| Medicare PECOS PAC ID | 6406160266 |
|---|---|
| Medicare Enrollment ID | O20150806012455 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205233558 | NPI | - | NPPES |
| 0043741-00 | Medicaid | FL | |
| 014263900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | ME 105503 (Florida) | Primary |
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (* (Not Available)) | Secondary |
| Provider Name | Silvana Gonzalez Reiley |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1952682783 PECOS PAC ID: 4183881923 Enrollment ID: I20120206000514 |
| Provider Name | Mayelin Gonzalez Alonso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750745733 PECOS PAC ID: 2466825872 Enrollment ID: I20230306002930 |
| Provider Name | Luz Reiley |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1508421405 PECOS PAC ID: 5698213718 Enrollment ID: I20240820001506 |
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