Provider Demographics
NPI:1982686051
Name:MATEO-REYES, ENID M (MD)
Entity Type:Individual
Prefix:DR
First Name:ENID
Middle Name:M
Last Name:MATEO-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 1:200 AVE JESUS T PINERO
Mailing Address - Street 2:HATO REY PLAZA APT 7A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4109
Mailing Address - Country:US
Mailing Address - Phone:787-763-9647
Mailing Address - Fax:787-706-2816
Practice Address - Street 1:1441 AVE ROOSEVELT
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2717
Practice Address - Country:US
Practice Address - Phone:787-749-4055
Practice Address - Fax:787-706-2816
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine