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General NPI Number Information
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NPI Number | 1508575150
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Entity Type | Individual
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Provider Name | AXEL MANUEL RIVERA REYES PSYD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | CARR # 2 KM 92.6 INT URB. INDUSTRIAL
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City | CAMUY
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State | PR
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Zip | 00627
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Country | US
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Telephone | 939-272-8530
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Fax |
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Provider Business Mailing Address
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Address Line | 53 CALLE SAN JUAN N
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City | CAMUY
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State | PR
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Zip | 00627-2560
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Country | US
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Telephone | 787-610-7977
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 07854
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License Number State | PR
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