Provider Demographics
NPI:1497796940
Name:REYES SEDA, AITZA (MD)
Entity Type:Individual
Prefix:
First Name:AITZA
Middle Name:
Last Name:REYES SEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AITZA
Other - Middle Name:
Other - Last Name:REYES SEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1357 AVE ASHFORD
Mailing Address - Street 2:PMB 427
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1400
Mailing Address - Country:US
Mailing Address - Phone:787-525-9700
Mailing Address - Fax:787-977-8010
Practice Address - Street 1:HOSPITAL WILMA VAZQUEZ
Practice Address - Street 2:SUITE 107
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-0000
Practice Address - Country:US
Practice Address - Phone:787-525-9700
Practice Address - Fax:787-977-8010
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13,281OtherLICENCIA MEDICO