Provider Demographics
NPI:1538716261
Name:REDNOSTIC MEDICAL, PSC
Entity type:Organization
Organization Name:REDNOSTIC MEDICAL, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZZOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-420-4054
Mailing Address - Street 1:156 SURENA HACIENDA SAN JOSE
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-342-1042
Mailing Address - Fax:
Practice Address - Street 1:898 MUNOZ RIVERA STE 300 HYDE PARK
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-342-1042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty