Provider Demographics
NPI:1336954700
Name:REYES-VAZQUEZ, GABRIELA MARIA (PHD)
Entity type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:MARIA
Last Name:REYES-VAZQUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 AVE WINSTON CHURCHILL APT 106
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6710
Mailing Address - Country:US
Mailing Address - Phone:787-358-3096
Mailing Address - Fax:
Practice Address - Street 1:400 AVE DOMENECH STE 606
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3746
Practice Address - Country:US
Practice Address - Phone:787-358-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical