Provider Demographics
NPI:1366451239
Name:REYES CRUZ, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:REYES CRUZ
Suffix:
Gender:M
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:PO BOX 1582
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1582
Mailing Address - Country:US
Mailing Address - Phone:787-863-6116
Mailing Address - Fax:787-863-1151
Practice Address - Street 1:5A1 CALLE 5-1
Practice Address - Street 2:MONTE BRISAS 5TA EXT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3111
Practice Address - Country:US
Practice Address - Phone:787-863-6116
Practice Address - Fax:787-863-1151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10869208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF-68152Medicare UPIN
PR83330Medicare ID - Type Unspecified