Healthcare Provider Details

I. General information

NPI: 1912869793
Provider Name (Legal Business Name): AMARILES REYES CORDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OFFICE PLAZA 65, CALLE ALONDRA 90
SAN JUAN PR
00726
US

IV. Provider business mailing address

URB HIGHLAND PARK 737 CALLE CAFETO
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-773-1816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7666
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: