MEDICARE: CHRISTINE MARIE REYNOSO MD

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	207R00000X	Internal Medicine Physician	11195	NV

General Provider Information

NPI Number	:	1851362438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MARIE REYNOSO MD

Provider Business Mailing Address
First Line	:	PO BOX 15645
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-5645
Country	:	US
Telephone Number	:
Fax Number	:	702-240-8790

Provider Business Practice Location Address
First Line	:	2350 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2149
Country	:	US
Telephone Number	:	702-877-8600
Fax Number	:	702-242-7944

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	01/30/2008

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