Healthcare Provider Details

I. General information

NPI: 1386749687
Provider Name (Legal Business Name): WENCESLAO REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1753 CALLE PAFOS URB VENUS GRDENS
SAN JUAN PR
00926
US

IV. Provider business mailing address

#1753 CALLE PAFOS URB VENUS GRDENS
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-605-7317
  • Fax:
Mailing address:
  • Phone: 787-605-7317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number399
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: