MEDICARE: JOSE S. REYES TORRES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	17478	PR
2	208C00000X	Colon & Rectal Surgery Physician	17478	PR

General Provider Information

NPI Number	:	1104028521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE S. REYES TORRES

Provider Business Mailing Address
First Line	:	PO BOX 2528
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00970-2528
Country	:	US
Telephone Number	:	787-957-6262
Fax Number	:	787-301-1186

Provider Business Practice Location Address
First Line	:	400 AVE FD ROOSEVELT
Second Line	:	STE 202
City	:	SAN JUAN
State	:	PR
Zip	:	00918-2129
Country	:	US
Telephone Number	:	787-621-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	03/10/2021

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