Healthcare Provider Details

I. General information

NPI: 1497796940
Provider Name (Legal Business Name): AITZA REYES SEDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AITZA REYES SEDA MD

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL WILMA VAZQUEZ SUITE 107
VEGA BAJA PR
00693-0000
US

IV. Provider business mailing address

1357 AVE ASHFORD PMB 427
SAN JUAN PR
00907-1400
US

V. Phone/Fax

Practice location:
  • Phone: 787-525-9700
  • Fax: 787-977-8010
Mailing address:
  • Phone: 787-525-9700
  • Fax: 787-977-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13281
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: