Provider Demographics
NPI:1811094139
Name:REYES MARTINEZ, LISBETH
Entity type:Individual
Prefix:DR
First Name:LISBETH
Middle Name:
Last Name:REYES MARTINEZ
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:MF7 PLAZA 23
Mailing Address - Street 2:MONTECLARO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4738
Mailing Address - Country:US
Mailing Address - Phone:787-862-4124
Mailing Address - Fax:
Practice Address - Street 1:CARR 174 BLOQUE 21 #25
Practice Address - Street 2:SANTA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-862-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11471208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0010857OtherHUMANA
PR060201OtherCRUZ AZUL
PR88671OtherTRIPLE SSS, INC
PR8977OtherUNITED HEALTH CARE
PR201953OtherPREFERRED HEALTH
PRPG3256OtherPALIC
PR0300OtherINTERNATIONAL MEDICAL CAR
PR8195OtherFEDERACION DE MAESTROS
PRPG3256OtherPALIC
PR8195OtherFEDERACION DE MAESTROS