Provider Demographics
NPI:1104028521
Name:REYES TORRES, JOSE S
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:S
Last Name:REYES TORRES
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:PO BOX 2528
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-2528
Mailing Address - Country:US
Mailing Address - Phone:787-957-6262
Mailing Address - Fax:787-301-1186
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:STE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2129
Practice Address - Country:US
Practice Address - Phone:787-621-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17478208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery