Provider Demographics
NPI:1770978900
Name:REYES OLIVA, JOSE SALVADOR (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:SALVADOR
Last Name:REYES OLIVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 27TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-3718
Mailing Address - Country:US
Mailing Address - Phone:786-371-4188
Mailing Address - Fax:
Practice Address - Street 1:3025 SHRINE RD STE 270
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4785
Practice Address - Country:US
Practice Address - Phone:912-262-2723
Practice Address - Fax:877-244-5666
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN26087390200000X
GA85416207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty