Provider Demographics
NPI:1629383609
Name:FORNARIS PARAVISINI, REINALDO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:REINALDO
Middle Name:JOSE
Last Name:FORNARIS PARAVISINI
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:JARDINES METROPOLITANOS #1. 355 GALILEO STREET.
Mailing Address - Street 2:SUITE # 8L
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-0692
Mailing Address - Country:US
Mailing Address - Phone:787-528-5531
Mailing Address - Fax:
Practice Address - Street 1:JARDINES METROPOLITANOS #1. 355 GALILEO STREET.
Practice Address - Street 2:SUITE # 8L
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-0692
Practice Address - Country:US
Practice Address - Phone:787-528-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0190162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR019016OtherMD LICENSE
PA208493OtherPHILADELPHIA MT LICENSE
PR12686-IOtherM.D. LISCENSE