Healthcare Provider Details

I. General information

NPI: 1437127818
Provider Name (Legal Business Name): GLORIA E REYES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MEDICO UPR SCHOOL OF MEDICINE
SAN JUAN PR
00929-0134
US

IV. Provider business mailing address

108 CALLE AMATISTA URB. GOLDEN GATE
GUAYNABO PR
00968-3421
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3225
  • Fax: 787-758-5307
Mailing address:
  • Phone: 787-396-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4281
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: