Provider Demographics
NPI:1740477579
Name:PEREZ-REYES, WANDA I (MD)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:I
Last Name:PEREZ-REYES
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 3407
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-6407
Mailing Address - Country:US
Mailing Address - Phone:787-636-5505
Mailing Address - Fax:
Practice Address - Street 1:CALLE ANTONIO LOPEZ
Practice Address - Street 2:ESQUINA TURQUESA #107 SUR
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-9595
Practice Address - Fax:787-719-6424
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16878208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice