Provider Demographics
NPI:1154867190
Name:REYES-ESTRADA, MARCOS JAVIER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:JAVIER
Last Name:REYES-ESTRADA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HACIENDA LAS CEIBAS
Mailing Address - Street 2:LOS ROMEROS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-328-7009
Mailing Address - Fax:
Practice Address - Street 1:550 CALLE SERGIO CUEVAS BUSTAMANTE
Practice Address - Street 2:ESQ. AVE DOMENECH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2637
Practice Address - Country:US
Practice Address - Phone:787-602-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-15
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5712103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical