Provider Demographics
NPI:1356588818
Name:REYES, NIELSON JOSE (M D)
Entity type:Individual
Prefix:DR
First Name:NIELSON
Middle Name:JOSE
Last Name:REYES
Suffix:
Gender:M
Credentials:M D
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 1
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0001
Mailing Address - Country:US
Mailing Address - Phone:787-384-6611
Mailing Address - Fax:787-816-8472
Practice Address - Street 1:CHALETS SAN LORENZO
Practice Address - Street 2:304 C
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-384-6611
Practice Address - Fax:787-816-8472
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17457208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice