Provider Demographics
NPI:1750436093
Name:REYES, RAUL (PSY)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:PSY
Other - Prefix:DR
Other - First Name:RAUL
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY
Mailing Address - Street 1:205 CALLE GUANAHANI
Mailing Address - Street 2:URB. COLINAS DE BAYOAN
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-3763
Mailing Address - Country:US
Mailing Address - Phone:787-404-9886
Mailing Address - Fax:787-404-9886
Practice Address - Street 1:205 CALLE GUANAHANI
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-3763
Practice Address - Country:US
Practice Address - Phone:787-404-9886
Practice Address - Fax:787-404-9886
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2789103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRGG285AMedicare Oscar/Certification