Provider Demographics
NPI:1427164565
Name:REYES, EDMUNDO RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUNDO
Middle Name:RAFAEL
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1774
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-1774
Mailing Address - Country:US
Mailing Address - Phone:787-657-7988
Mailing Address - Fax:787-657-7988
Practice Address - Street 1:L2 CALLE 6
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-2825
Practice Address - Country:US
Practice Address - Phone:787-657-7988
Practice Address - Fax:787-657-7988
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5429174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist