Healthcare Provider Details

I. General information

NPI: 1063149805
Provider Name (Legal Business Name): REYNALDO LLUBERES MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 07/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLA FONTANA VIA DIANA TR3
CAROLINA PR
00983
US

IV. Provider business mailing address

URB VILLA FONTANA VIA DIANA TR3
CAROLINA PR
00983
US

V. Phone/Fax

Practice location:
  • Phone: 787-340-5934
  • Fax:
Mailing address:
  • Phone: 787-340-5934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number120795
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: