Provider Demographics
NPI:1710979471
Name:URBINA REYES, BRENDA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:Y
Last Name:URBINA REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA MEDICAL CENTER, DEPARTMENT OF MEDICINE, 3RD FLOOR
Mailing Address - Street 2:10 CALLE CASIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3201
Mailing Address - Country:US
Mailing Address - Phone:787-641-3669
Mailing Address - Fax:787-641-4561
Practice Address - Street 1:VA MEDICAL CENTER, DEPT. OF MEDICINE, 3RD FLOOR
Practice Address - Street 2:10 CALLE CASIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-641-3669
Practice Address - Fax:787-641-4561
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041330207RI0200X
PR16746207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001413301Medicaid
CT001413301Medicaid
CTH84969Medicare UPIN