Healthcare Provider Details

I. General information

NPI: 1356479570
Provider Name (Legal Business Name): MAYRA V REYES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E-7 MARGINAL SANTA CRUZ SANTA ROSA
BAYAMON PR
00956
US

IV. Provider business mailing address

PO BOX 16804
SAN JUAN PR
00908
US

V. Phone/Fax

Practice location:
  • Phone: 787-690-9018
  • Fax:
Mailing address:
  • Phone: 787-690-9018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9650
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: