Provider Demographics
NPI:1881400844
Name:REYES CARTAGENA, JONATHAN
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:REYES CARTAGENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 S WILLIAMSON BLVD APT 6-104
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7368
Mailing Address - Country:US
Mailing Address - Phone:787-362-8584
Mailing Address - Fax:
Practice Address - Street 1:5410 S WILLIAMSON BLVD APT 6-104
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-7368
Practice Address - Country:US
Practice Address - Phone:787-362-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor