Provider Demographics
NPI:1407272826
Name:REYES, LILLIAN
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:
Last Name:REYES
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 1:201 AVE DE DIEGO
Mailing Address - Street 2:PLAZA SAN FRANCISCO SUITE 203
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5812
Mailing Address - Country:US
Mailing Address - Phone:787-672-8101
Mailing Address - Fax:
Practice Address - Street 1:201 AVE DE DIEGO
Practice Address - Street 2:PLAZA SAN FRANCISCO SUITE 203
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5812
Practice Address - Country:US
Practice Address - Phone:787-672-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005540103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical