Provider Demographics
NPI:1063129666
Name:REYES VARGAS, JOSE RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAFAEL
Last Name:REYES VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 VALENTINE AVE APT 12A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-7252
Mailing Address - Country:US
Mailing Address - Phone:646-670-6004
Mailing Address - Fax:
Practice Address - Street 1:2302 VALENTINE AVE APT 12A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-7252
Practice Address - Country:US
Practice Address - Phone:646-670-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-489246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant