Provider Demographics
NPI:1285211193
Name:REYES ROSARIO, CORAL CRISTINA
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:CRISTINA
Last Name:REYES ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 CARR 169 APT 303
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4278
Mailing Address - Country:US
Mailing Address - Phone:787-692-9172
Mailing Address - Fax:
Practice Address - Street 1:540 CARR 169 APT 303
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4278
Practice Address - Country:US
Practice Address - Phone:787-692-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36138207V00000X
390200000X
PR23433208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program