Healthcare Provider Details

I. General information

NPI: 1962628909
Provider Name (Legal Business Name): CENTRO VACUNACION DR REYES CABEZA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 04/15/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SAN ANTONIO 539 RAMAL CARR 2
PONCE PR
00728-0000
US

IV. Provider business mailing address

1575 AVE MUNOZ RIVERA PMB 281
PONCE PR
00717-0211
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-8945
  • Fax: 787-290-4472
Mailing address:
  • Phone: 787-842-8945
  • Fax: 787-290-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number8809
License Number StatePR

VIII. Authorized Official

Name: DR. VICTOR REYES CABEZA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-842-8945