Provider Demographics
NPI:1730905084
Name:REYES DE JESUS, ISAURA
Entity type:Individual
Prefix:
First Name:ISAURA
Middle Name:
Last Name:REYES DE JESUS
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 1:363 CALLE FLAMBOYAN DEL RIO VILLA PALMERA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915
Mailing Address - Country:US
Mailing Address - Phone:787-486-2579
Mailing Address - Fax:
Practice Address - Street 1:363 CALLE DEL RIO VILLA PALMERA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915
Practice Address - Country:US
Practice Address - Phone:787-486-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program