Healthcare Provider Details

I. General information

NPI: 1457919250
Provider Name (Legal Business Name): XIOMARA CUADRADO REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB SANTA CRUZ B7 CALLE SANTA CRUZ
BAYAMON PR
00961-6904
US

IV. Provider business mailing address

URB SANTA CRUZ B7 CALLE SANTA CRUZ
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-625-6120
  • Fax: 787-625-6124
Mailing address:
  • Phone: 787-625-6120
  • Fax: 787-625-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number12963
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: