Provider Demographics
NPI:1689649352
Name:REYES, CARMEN LYDIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:LYDIA
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND BONNEVILLE
Mailing Address - Street 2:CALLE 2 F19
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5606
Mailing Address - Country:US
Mailing Address - Phone:787-744-4721
Mailing Address - Fax:
Practice Address - Street 1:COND BONNEVILLE
Practice Address - Street 2:CALLE 2 F19
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5606
Practice Address - Country:US
Practice Address - Phone:787-744-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11626208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11626OtherMEDICAL LICENSE