Healthcare Provider Details

I. General information

NPI: 1265354724
Provider Name (Legal Business Name): ROSA JESENIA REYES CRUZ LCDA.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 CALLE GARDENIA
TRUJILLO ALTO PR
00976-2703
US

IV. Provider business mailing address

159 CALLE GARDENIA
TRUJILLO ALTO PR
00976-2703
US

V. Phone/Fax

Practice location:
  • Phone: 787-674-2741
  • Fax:
Mailing address:
  • Phone: 787-674-2741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1917
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: