Provider Demographics
NPI:1407147861
Name:NORIEGA REYNOSO, CONSUELO ROSARIO (MD)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:ROSARIO
Last Name:NORIEGA REYNOSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CONSUELO
Other - Middle Name:ROSARIO
Other - Last Name:NORIEGA-ROJAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CENTER/C&A PSYCHIATRY
Mailing Address - Street 2:PUTNAM HALL, SOUTH CAMPUS
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8790
Mailing Address - Country:US
Mailing Address - Phone:631-632-8840
Mailing Address - Fax:631-632-8953
Practice Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CENTER/C&A PSYCHIATRY
Practice Address - Street 2:PUTNAM HALL, SOUTH CAMPUS
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8790
Practice Address - Country:US
Practice Address - Phone:631-632-8840
Practice Address - Fax:631-632-8953
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program