Provider Demographics
NPI:1184703365
Name:REYES, LETICIA MARGARITA (PSYD)
Entity type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:MARGARITA
Last Name:REYES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ST #2
Mailing Address - Street 2:VILLA NEVAREZ PROFESSIONAL CENTER SUITE 304
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-764-3371
Mailing Address - Fax:787-764-3371
Practice Address - Street 1:120 ST #2
Practice Address - Street 2:VILLA NEVAREZ PROFESSIONAL CENTER SUITE 304
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-764-3371
Practice Address - Fax:787-764-3371
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P75583Medicare UPIN
0062645Medicare ID - Type Unspecified