Provider Demographics
NPI:1265160204
Name:REYES AGUIRRE, MARISOL A
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:A
Last Name:REYES AGUIRRE
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:URB. VILLA RETIRO M21
Mailing Address - Street 2:CALLE TENIENTE BERMUDEZ
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-599-8056
Mailing Address - Fax:
Practice Address - Street 1:GLENVIEW GARDENS
Practice Address - Street 2:F2 CALLE ESTADIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-1779
Practice Address - Country:US
Practice Address - Phone:787-599-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty