Provider Demographics
NPI:1033187067
Name:ABREU-DELIZ, JOSE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:ABREU-DELIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:RAFAEL
Other - Last Name:ABREU-DELIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:CALLE EBANO 1-7
Mailing Address - Street 2:APT. 401
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-309-2107
Mailing Address - Fax:787-767-0857
Practice Address - Street 1:CALLE EBANO 1-7
Practice Address - Street 2:APT. 401
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-309-2107
Practice Address - Fax:787-767-0857
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3275207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD-32956Medicare UPIN
PRD32956Medicare UPIN