MEDICARE: ALMA ALICIA REYES ESTRADA M.D.

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	208D00000X	General Practice Physician	19559	PR

General Provider Information

NPI Number	:	1134667256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALMA ALICIA REYES ESTRADA M.D.

Provider Business Mailing Address
First Line	:	6471 AVE ISLA VERDE APT 1001
Second Line	:	CONDOMINIO NEW SAN JUAN
City	:	CAROLINA
State	:	PR
Zip	:	00979-7121
Country	:	US
Telephone Number	:	323-422-5681
Fax Number	:

Provider Business Practice Location Address
First Line	:	6471 AVE ISLA VERDE APT 1001
Second Line	:	CONDOMINIO NEW SAN JUAN
City	:	CAROLINA
State	:	PR
Zip	:	00979-7121
Country	:	US
Telephone Number	:	323-422-5681
Fax Number	:

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

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	02/09/2017

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