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General NPI Number Information
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NPI Number | 1386392793
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Entity Type | Individual
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Provider Name | KEYSHA KARELIS REYES OLIVO MD
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Gender | Female
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 315-321 CLL 25 NE
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City | SAN JUAN
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State | PR
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Zip | 00820
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Country | US
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Telephone | 787-480-5277
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE MAGA M5 QUINTAS DE DORADO
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-518-3598
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 22920
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License Number State | PR
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