Healthcare Provider Details

I. General information

NPI: 1407678162
Provider Name (Legal Business Name): LUIS M REYES BAEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 1 BOX 6042
GUAYNABO PR
00971-9535
US

IV. Provider business mailing address

HC 1 BOX 6042
GUAYNABO PR
00971-9535
US

V. Phone/Fax

Practice location:
  • Phone: 787-361-8580
  • Fax:
Mailing address:
  • Phone: 787-361-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: