Provider Demographics
NPI:1700887080
Name:DELIZ, REINALDO A (DMD)
Entity Type:Individual
Prefix:DR
First Name:REINALDO
Middle Name:A
Last Name:DELIZ
Suffix:
Gender:M
Credentials:DMD
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 3295
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3295
Mailing Address - Country:US
Mailing Address - Phone:787-834-7777
Mailing Address - Fax:787-834-3006
Practice Address - Street 1:2599 AVE HOSTOS
Practice Address - Street 2:SUITE #2
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6400
Practice Address - Country:US
Practice Address - Phone:787-834-7777
Practice Address - Fax:787-834-3006
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1211122300000X
TX17409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist