1003808742 NPI number — ELBA ROSA MARTIN REYES MD

Table of content: ELBA ROSA MARTIN REYES MD (NPI 1003808742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003808742 NPI number — ELBA ROSA MARTIN REYES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN REYES
Provider First Name:
ELBA
Provider Middle Name:
ROSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003808742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
87 CARRET 20 COND LA ARBOLEDA
Provider Second Line Business Mailing Address:
APT 1603
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-782-4156
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE SAN PATRICIO # 101
Provider Second Line Business Practice Location Address:
MARAMAR PLAZA SUITE 1240
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00968-4484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-508-5445
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  16147 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16147 . This is a "MEDICAL LISENCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com