Provider Demographics
NPI:1598874216
Name:REYES VIZCARRONDO, ANTONIO A (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:A
Last Name:REYES VIZCARRONDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTONIO
Other - Middle Name:ALFONSO
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PIO BAROJA 371
Mailing Address - Street 2:EL SENORIAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-633-6601
Mailing Address - Fax:787-293-2986
Practice Address - Street 1:HOSPITAL MENONITA CIDEA
Practice Address - Street 2:AVE EL JIBARO
Practice Address - City:CICRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13801207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002117Medicare ID - Type Unspecified