Provider Demographics
NPI:1104803113
Name:REYES, VICTOR MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:REYES
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 1:7 URB CAUTIVA
Mailing Address - Street 2:CALLE ALMACIGOS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3118
Mailing Address - Country:US
Mailing Address - Phone:787-238-3095
Mailing Address - Fax:
Practice Address - Street 1:AC7 CALLE RODRIGO DE TRIANA
Practice Address - Street 2:RES. BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-5975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-15143Medicare UPIN
PR0022474Medicare ID - Type UnspecifiedPROVIDER NUMBER