Provider Demographics
NPI:1376545087
Name:CABEZA, VICTOR REYES SR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:REYES
Last Name:CABEZA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1913 AVE LAS AMERICAS
Mailing Address - Street 2:URB SAN ANTONIO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1815
Mailing Address - Country:US
Mailing Address - Phone:787-842-8945
Mailing Address - Fax:787-842-8945
Practice Address - Street 1:1913 AVE LAS AMERICAS
Practice Address - Street 2:URB SAN ANTONIO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1815
Practice Address - Country:US
Practice Address - Phone:787-842-8945
Practice Address - Fax:787-842-8945
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8809208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29745Medicare ID - Type UnspecifiedCMS/ MEDICARE
PRG00417Medicare UPIN