Healthcare Provider Details

I. General information

NPI: 1316795396
Provider Name (Legal Business Name): EMELY M REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1999
BAYAMON PR
00960-1999
US

IV. Provider business mailing address

URB SANTA ROSA CALLE 13 BLOQ 28 -23
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-8282
  • Fax:
Mailing address:
  • Phone: 787-949-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25196
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: