MEDICARE: MARK REYES SR.

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1730891482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK REYES SR.

Provider Business Mailing Address
First Line	:	13305 S RIDGELAND AVE UNIT C
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13305 S RIDGELAND AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1808
Country	:	US
Telephone Number	:	708-907-5149
Fax Number	:

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

Provider Enumeration Date	:	12/14/2022
Last Update Date	:	12/14/2022

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Directions to “ MARK REYES SR. ” Practice Location

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