Healthcare Provider Details

I. General information

NPI: 1891706727
Provider Name (Legal Business Name): ROSAURA AGUAYO REYES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/30/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE GEORGETTI #18, CARR. 167
COMERIO PR
00782
US

IV. Provider business mailing address

CALLE GEORGETTI #18, CARR. 167
COMERIO PR
00782
US

V. Phone/Fax

Practice location:
  • Phone: 787-875-3375
  • Fax: 787-875-4230
Mailing address:
  • Phone: 787-875-3375
  • Fax: 787-875-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8715
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9180354
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerHUMANA
# 2
Identifier203855
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPREFERRED
# 3
Identifier81280
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerSSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: