Healthcare Provider Details

I. General information

NPI: 1790759595
Provider Name (Legal Business Name): JOAQUIN ALBERTO REYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 AVE DOMENECH
SAN JUAN PR
00918-3718
US

IV. Provider business mailing address

655 CALLE COLLINS SUMMIT HILLS
SAN JUAN PR
00920-4341
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-1110
  • Fax: 787-751-1655
Mailing address:
  • Phone: 939-969-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15130
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number15130
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: