Provider Demographics
NPI:1548340482
Name:PEREZ REYES, VICTORIA (PSY D)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:PEREZ REYES
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RIO GRANDE STATES
Mailing Address - Street 2:11406 REY LUIS XV
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0000
Mailing Address - Country:US
Mailing Address - Phone:787-630-8067
Mailing Address - Fax:
Practice Address - Street 1:NEW SAN JUAN COMERCIAL LOCAL 4
Practice Address - Street 2:6471 ISLA VERDE AVE
Practice Address - City:ISLA VERDE
Practice Address - State:PR
Practice Address - Zip Code:00979-0000
Practice Address - Country:US
Practice Address - Phone:787-630-8067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1480103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical