Healthcare Provider Details

I. General information

NPI: 1023917747
Provider Name (Legal Business Name): CAMILA MARIA REYES SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 10/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE LAUREL SANTA JUANITA
BAYAMON PR
00960
US

IV. Provider business mailing address

URB. FUENTEBELLA CALLE SORRENTO1572
TOA ALTA PR
00953
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-3001
  • Fax:
Mailing address:
  • Phone: 787-919-1572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6874787
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: