Provider Demographics
NPI:1891864138
Name:FONTANEZ REYES, NYDIA E (MD)
Entity Type:Individual
Prefix:MISS
First Name:NYDIA
Middle Name:E
Last Name:FONTANEZ REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ST 987 COND PENAMAR
Mailing Address - Street 2:C-609
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-801-0081
Mailing Address - Fax:787-863-3324
Practice Address - Street 1:55 CALLE DEL CARMEN W
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4717
Practice Address - Country:US
Practice Address - Phone:787-860-3558
Practice Address - Fax:787-860-7066
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15797173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine