=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316596125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEISHLA MARIE GARCIA REYES DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2019
-----------------------------------------------------
Last Update Date | 08/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1338 SANTANA STE 2
-----------------------------------------------------
City | ARECIBO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00612-6634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-817-6203
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 52 BOX 2113A
-----------------------------------------------------
City | GARROCHALES
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00652-9116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-460-6943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 695
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------