Provider Demographics
NPI:1659136794
Name:REYES-SOSA, GISELLE MARIE
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:MARIE
Last Name:REYES-SOSA
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 1:1030 CALLE 11 SE
Mailing Address - Street 2:REPARTO METROPOLITANO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3121
Mailing Address - Country:US
Mailing Address - Phone:787-414-2440
Mailing Address - Fax:
Practice Address - Street 1:1030 CALLE 11 SE
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3121
Practice Address - Country:US
Practice Address - Phone:787-414-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program