Healthcare Provider Details

I. General information

NPI: 1801876495
Provider Name (Legal Business Name): MARTHA DENISE REYES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE SAN CRISTABAL SUITE 313
COTO LAUREL PR
00780-0465
US

IV. Provider business mailing address

PO BOX 800465 TORRE SAN CRISTOBAL SUITE 313
COTO LAUREL PR
00780-0465
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-0001
  • Fax: 787-848-0009
Mailing address:
  • Phone: 787-848-0001
  • Fax: 787-848-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11472
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: