Healthcare Provider Details

I. General information

NPI: 1235101148
Provider Name (Legal Business Name): MILAGROS T. REYES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CALLE RAFAEL LAZA
AGUAS BUENAS PR
00703-3220
US

IV. Provider business mailing address

PO BOX 8549
CAGUAS PR
00726-8549
US

V. Phone/Fax

Practice location:
  • Phone: 787-924-7575
  • Fax: 787-924-7575
Mailing address:
  • Phone: 787-258-6970
  • Fax: 787-258-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number8536
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: