Healthcare Provider Details

I. General information

NPI: 1639986482
Provider Name (Legal Business Name): DESIRE D HERNANDEZ REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB PEREZ MORRIS #1 CALLE PONCE
SAN JUAN PR
00957
US

IV. Provider business mailing address

CHALETS DE ROYAL PALM EDIF 9 APT 907
BAYAMON PR
00956-3027
US

V. Phone/Fax

Practice location:
  • Phone: 787-677-1481
  • Fax:
Mailing address:
  • Phone: 787-677-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7959
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: