Provider Demographics
NPI:1720295157
Name:REYES ROSARIO, YADIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:YADIRA
Middle Name:
Last Name:REYES ROSARIO
Suffix:
Gender:F
Credentials:MD
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 1885
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-1885
Mailing Address - Country:US
Mailing Address - Phone:787-855-4011
Mailing Address - Fax:787-325-7738
Practice Address - Street 1:PANORAMA PLAZA 1841
Practice Address - Street 2:CARRETERA # 2 SUITE 1
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-325-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRGN073AMedicare PIN