=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609437037
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. LUDY E. REYES GONZALEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2019
-----------------------------------------------------
Last Update Date | 06/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | I18 CALLE CINDYA URB EL ENCANTO
-----------------------------------------------------
City | JUNCOS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-530-8385
-----------------------------------------------------
Fax | 787-703-0508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB EL ENCANTO 918 CALLE CINDYA
-----------------------------------------------------
City | JUNCOS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-530-8385
-----------------------------------------------------
Fax | 787-703-0508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 958879
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------