Healthcare Provider Details

I. General information

NPI: 1992782551
Provider Name (Legal Business Name): RICARDO JESUS REINA-SANABRIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 03/15/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 AVE CESAR GONZALEZ SUITE 506 DORAL BANK CENTER
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

100 GRAND BLVD PASEOS SUITE 112 MSC 313
SAN JUAN PR
00926-5955
US

V. Phone/Fax

Practice location:
  • Phone: 787-772-1007
  • Fax: 787-772-1009
Mailing address:
  • Phone: 787-287-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number13805
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: