Provider Demographics
NPI:1003902743
Name:GAONA REYES, CARLOS A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:GAONA REYES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:460 CALLE GAVIOTA
Mailing Address - Street 2:CAMINO DEL SUR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-284-0383
Mailing Address - Fax:787-987-9310
Practice Address - Street 1:1214 AVE MUNOZ RIVERA
Practice Address - Street 2:RECINTO UNIVERSITARIO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-284-0383
Practice Address - Fax:787-987-9310
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR13489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH72059Medicare UPIN
PR0021145Medicare PIN