Provider Demographics
NPI:1215553375
Name:REYES, DAMARYS (NL)
Entity Type:Individual
Prefix:
First Name:DAMARYS
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:NL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1528
Mailing Address - Country:US
Mailing Address - Phone:787-761-8870
Mailing Address - Fax:787-761-9516
Practice Address - Street 1:CARR.181 EXPRESO TRUJILLO ALTO KM.4.4 LOCAL #14
Practice Address - Street 2:CENTRO COMERCIAL LAGO ALTO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-761-8870
Practice Address - Fax:787-761-9516
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR140175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath