Provider Demographics
NPI:1215923834
Name:REYES, RAUL A
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:A
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18-4 CALLE 5
Mailing Address - Street 2:MANSIONES DE TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3312
Mailing Address - Country:US
Mailing Address - Phone:787-720-5123
Mailing Address - Fax:
Practice Address - Street 1:601 CALLE NIZA
Practice Address - Street 2:VILLA CAPRI
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4054
Practice Address - Country:US
Practice Address - Phone:787-760-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5904174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0097843OtherPTAN
PRD-26666Medicare UPIN