Provider Demographics
NPI:1285172668
Name:REYES-RIVERA, JOSE OSVALDO (PHD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:OSVALDO
Last Name:REYES-RIVERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 URB CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-9356
Mailing Address - Country:US
Mailing Address - Phone:787-615-1366
Mailing Address - Fax:
Practice Address - Street 1:36 URB CAMINO REAL
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-9356
Practice Address - Country:US
Practice Address - Phone:787-615-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health