Provider Demographics
NPI:1609437037
Name:REYES GONZALEZ, LUDY E
Entity Type:Individual
Prefix:MRS
First Name:LUDY
Middle Name:E
Last Name:REYES GONZALEZ
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:URB EL ENCANTO
Mailing Address - Street 2:918 CALLE CINDYA
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:787-530-8385
Mailing Address - Fax:787-703-0508
Practice Address - Street 1:I18 CALLE CINDYA
Practice Address - Street 2:URB EL ENCANTO
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-530-8385
Practice Address - Fax:787-703-0508
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9588793416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1047274-0013OtherCERTIFICADO REGISTRO DE COMERCIANTE