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General NPI Number Information
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NPI Number | 1427164565
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Entity Type | Individual
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Provider Name | EDMUNDO RAFAEL REYES M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | L2 CALLE 6 VILLAS DE RIO GRANDE
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City | RIO GRANDE
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State | PR
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Zip | 00745-2825
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Country | US
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Telephone | 787-657-7988
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Fax | 787-657-7988
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Provider Business Mailing Address
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Address Line | PO BOX 1774
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City | RIO GRANDE
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State | PR
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Zip | 00745-1774
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Country | US
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Telephone | 787-657-7988
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Fax | 787-657-7988
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5429
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License Number State | PR
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