Provider Demographics
NPI:1710021365
Name:REYES, WILFREDO (MT)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 AVE MAGDALENA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1728
Mailing Address - Country:US
Mailing Address - Phone:787-667-1033
Mailing Address - Fax:787-762-4200
Practice Address - Street 1:PC1 CALLE 274
Practice Address - Street 2:AVE COMANDANTE, COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2769
Practice Address - Country:US
Practice Address - Phone:787-762-4200
Practice Address - Fax:787-762-4200
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1202246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management