Healthcare Provider Details

I. General information

NPI: 1386629749
Provider Name (Legal Business Name): CESAR A REYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 1 CASA 4 URB SAN ANTONIO
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 300
HUMACAO PR
00792-0300
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-3888
  • Fax:
Mailing address:
  • Phone: 787-852-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7620
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: