MEDICARE: CARLOS H VIANA REYES MD

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	7212	PR

General Provider Information

NPI Number	:	1639181522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS H VIANA REYES MD

Provider Business Mailing Address
First Line	:	PO BOX 51513
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00950-1513
Country	:	US
Telephone Number	:	787-795-2935
Fax Number	:

Provider Business Practice Location Address
First Line	:	HF16 CALLE LIZZIE GRAHAM
Second Line	:	7MA SECCION LEVITTOWN
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3634
Country	:	US
Telephone Number	:	787-795-2935
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	09/20/2012

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