Provider Demographics
NPI:1508093154
Name:PEZZOTTI SMITH, REYNALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:
Last Name:PEZZOTTI SMITH
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 1:156 SUREA
Mailing Address - Street 2:HACIENDA SAN JOSE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-420-4054
Mailing Address - Fax:787-961-9447
Practice Address - Street 1:CIUDAD JARDIN 1, #117 ANTHURIUM ST.
Practice Address - Street 2:TOA ALTA,P.R.
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-4844
Practice Address - Country:US
Practice Address - Phone:787-646-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17615207QA0505X
FL1037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine