Provider Demographics
NPI:1457948051
Name:REVERON-REYES, ORLANDO JUAN
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:JUAN
Last Name:REVERON-REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:O14 CALLE 12
Mailing Address - Street 2:URB CUPEY GDNS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-529-8412
Mailing Address - Fax:
Practice Address - Street 1:BARRIO RINCON, SECTOR LOMAS
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-2800
Practice Address - Country:US
Practice Address - Phone:787-434-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program