Healthcare Provider Details

I. General information

NPI: 1710979471
Provider Name (Legal Business Name): BRENDA Y. URBINA REYES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CENTER, DEPT. OF MEDICINE, 3RD FLOOR 10 CALLE CASIA
SAN JUAN PR
00921-3201
US

IV. Provider business mailing address

VA MEDICAL CENTER, DEPARTMENT OF MEDICINE, 3RD FLOOR 10 CALLE CASIA
SAN JUAN PR
00921-3201
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-3669
  • Fax: 787-641-4561
Mailing address:
  • Phone: 787-641-3669
  • Fax: 787-641-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number041330
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number16746
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: