Healthcare Provider Details

I. General information

NPI: 1265456040
Provider Name (Legal Business Name): MARITZA TRINIDAD REYES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VETERANS HOSPITAL CASIA STREET NUMBER 10
RIO PIEDRAS PR
00926-6013
US

IV. Provider business mailing address

EL SONERIAL MAIL STATION BOX 641 WINSTON CHURCHILL AV.138
RIO PIEDRAS PR
00926-6013
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-7595
Mailing address:
  • Phone: 787-790-2089
  • Fax: 787-790-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number5963
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: