MEDICARE: CASIMIRA REYES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	05398592	TX

General Provider Information

NPI Number	:	1245948298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASIMIRA REYES

Provider Business Mailing Address
First Line	:	2533 CASTLE PINES DR
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-8801
Country	:	US
Telephone Number	:	817-933-1472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2533 CASTLE PINES DR
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-8801
Country	:	US
Telephone Number	:	817-933-1472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	11/08/2022

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Directions to “ CASIMIRA REYES ” Practice Location

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