=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508093154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REYNALDO PEZZOTTI SMITH M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2009
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CIUDAD JARDIN 1, #117 ANTHURIUM ST. TOA ALTA,P.R.
-----------------------------------------------------
City | TOA ALTA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00953-4844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-646-5905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 156 SUREA HACIENDA SAN JOSE
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-420-4054
-----------------------------------------------------
Fax | 787-961-9447
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | 17615
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 1037
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------