MEDICARE: DR. GRACIELA REINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2081	PR

General Provider Information

NPI Number	:	1902043532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACIELA REINA

Provider Business Mailing Address
First Line	:	177 LAS CAOBAS
Second Line	:	HYDE PARK
City	:	SAN JUAN
State	:	PR
Zip	:	00927-3240
Country	:	US
Telephone Number	:	787-753-1899
Fax Number	:	787-758-4561

Provider Business Practice Location Address
First Line	:	#177 LAS CAOBAS
Second Line	:	HYDE PARK URB
City	:	SAN JUAN
State	:	PR
Zip	:	00927-3240
Country	:	US
Telephone Number	:	787-753-1899
Fax Number	:	787-758-4561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	01/20/2009

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Directions to “ DR. GRACIELA REINA ” Practice Location

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