Provider Demographics
NPI:1639181522
Name:VIANA REYES, CARLOS H (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:H
Last Name:VIANA REYES
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:PO BOX 51513
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1513
Mailing Address - Country:US
Mailing Address - Phone:787-795-2935
Mailing Address - Fax:
Practice Address - Street 1:HF16 CALLE LIZZIE GRAHAM
Practice Address - Street 2:7MA SECCION LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3634
Practice Address - Country:US
Practice Address - Phone:787-795-2935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7212208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029609Medicare ID - Type UnspecifiedMEDICARE PR
PRC77706Medicare UPIN