Provider Demographics
NPI:1619092236
Name:REYES-PESANTE, SARA M (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:REYES-PESANTE
Suffix:
Gender:F
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:E17 CALLE BENITEZ
Mailing Address - Street 2:SIERRA BERDECIA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6231
Mailing Address - Country:US
Mailing Address - Phone:787-790-6202
Mailing Address - Fax:
Practice Address - Street 1:E17 CALLE BENITEZ
Practice Address - Street 2:SIERRA BERDECIA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-6231
Practice Address - Country:US
Practice Address - Phone:787-790-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15489208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice