Healthcare Provider Details

I. General information

NPI: 1942984034
Provider Name (Legal Business Name): CRISTINA PAOLA REYES NIEVES PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 AVE PONCE DE LEON STE 604
SAN JUAN PR
00909-1844
US

IV. Provider business mailing address

PO BOX 924
BARCELONETA PR
00617-0924
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-9797
  • Fax:
Mailing address:
  • Phone: 787-503-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6689
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: