Provider Demographics
NPI:1689832073
Name:REYES, ALEXANDRA (LND, RD)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:LND, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H17 A VILLA DEL CARMEN MUNOZ MARIN AVE
Mailing Address - Street 2:NUTRITION SERVICES OFFICE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-758-2000
Mailing Address - Fax:
Practice Address - Street 1:1715 AVE PONCE DE LEON
Practice Address - Street 2:NUTRITION DEPARTMENT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1958
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1250133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education