Provider Demographics
NPI:1134667256
Name:REYES ESTRADA, ALMA ALICIA (MD)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:ALICIA
Last Name:REYES ESTRADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6471 AVE ISLA VERDE APT 1001
Mailing Address - Street 2:CONDOMINIO NEW SAN JUAN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-7121
Mailing Address - Country:US
Mailing Address - Phone:323-422-5681
Mailing Address - Fax:
Practice Address - Street 1:6471 AVE ISLA VERDE APT 1001
Practice Address - Street 2:CONDOMINIO NEW SAN JUAN
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-7121
Practice Address - Country:US
Practice Address - Phone:323-422-5681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19559208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice