MEDICARE: DR. VICTOR REYES CABEZA SR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	8809	PR

General Provider Information

NPI Number	:	1376545087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR REYES CABEZA SR. M.D.

Provider Business Mailing Address
First Line	:	1913 AVE LAS AMERICAS
Second Line	:	URB SAN ANTONIO
City	:	PONCE
State	:	PR
Zip	:	00728-1815
Country	:	US
Telephone Number	:	787-842-8945
Fax Number	:	787-842-8945

Provider Business Practice Location Address
First Line	:	1913 AVE LAS AMERICAS
Second Line	:	URB SAN ANTONIO
City	:	PONCE
State	:	PR
Zip	:	00728-1815
Country	:	US
Telephone Number	:	787-842-8945
Fax Number	:	787-842-8945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	03/04/2013

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