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General NPI Number Information
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NPI Number | 1245748318
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Entity Type | Organization
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Legal Business Name | DYNAMIC PSYCHIATRIC SOLUTIONS LLC
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 22 AVE LOS MAESTROS
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City | MAYAGUEZ
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State | PR
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Zip | 00682-5952
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Country | US
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Telephone | 787-585-1588
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Fax |
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Provider Business Mailing Address
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Address Line | 22 AVE LOS MAESTROS
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City | MAYAGUEZ
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State | PR
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Zip | 00682-5952
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Country | US
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Telephone | 787-585-1588
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. HECTOR LUIS RIVERA REYES
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Credential | MD
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Telephone | 787-585-1588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 18030
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 18030
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License Number State | PR
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