Healthcare Provider Details

I. General information

NPI: 1770248957
Provider Name (Legal Business Name): JAYSON RAMIREZ REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 08/08/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONS MED PLAZA STE 307A 201 AVE GAUTIER BENITEZ
GUAYNABO PR
00725
US

IV. Provider business mailing address

CONS MED PLAZA STE 307A 201 AVE GAUTIER BENITEZ
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-957-8282
  • Fax: 787-665-1165
Mailing address:
  • Phone: 787-957-8282
  • Fax: 787-665-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11015903
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4057
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: