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1386392793 NPI number — KEYSHA KARELIS REYES OLIVO MD

NPI Number: 1386392793
Health Care Provider/Practitioner: KEYSHA KARELIS REYES OLIVO MD

Information about “1386392793” NPI (KEYSHA KARELIS REYES OLIVO MD) exists in 1386392793 in HTML format HTML  |  1386392793 in plain Text format TXT  |  1386392793 in PDF (Portable Document Format) PDF  |  1386392793 in an XML format XML  formats.

NPI Number : 1386392793 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386392793",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "REYES OLIVO",
    "FirstName": "KEYSHA",
    "MiddleName": "KARELIS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "CALLE MAGA M5 QUINTAS DE DORADO",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DORADO",
    "MailingAddressStateName": "PR",
    "MailingAddressPostalCode": "00646",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "787-518-3598",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "315-321 CLL 25 NE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN JUAN",
    "PracticeLocationAddressStateName": "PR",
    "PracticeLocationAddressPostalCode": "00820",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "787-480-5277",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/15/2022",
    "LastUpdateDate": "12/20/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208D00000X",
          "TaxonomyName": "General Practice Physician",
          "LicenseNumber": "22920",
          "LicenseNumberStateCode": "PR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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