Provider Demographics
NPI:1578661427
Name:REYES-ALICEA, ANGEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:M
Last Name:REYES-ALICEA
Suffix:
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:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-1218
Mailing Address - Country:US
Mailing Address - Phone:787-720-9190
Mailing Address - Fax:787-790-9109
Practice Address - Street 1:B1 CALLE ARGENTINA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2038
Practice Address - Country:US
Practice Address - Phone:787-720-9190
Practice Address - Fax:787-790-9109
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6551207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028731Medicare PIN
PR0028731Medicare ID - Type Unspecified