Healthcare Provider Details

I. General information

NPI: 1700308616
Provider Name (Legal Business Name): EMMA REYES ARQUITOLA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 12/04/2018
Certification Date: ARQUITOLA EMMA REYES 1400 AFFLINK PL STE 101 TUSCALOOSA AL 35406 207 ADELE ST RAINBOW AL 35906
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 ADELE ST
RAINBOW AL
35906
US

IV. Provider business mailing address

1400 AFFLINK PL STE 101
TUSCALOOSA AL
35406-2289
US

V. Phone/Fax

Practice location:
  • Phone: (256) 442-8033
  • Fax:
Mailing address:
  • Phone: 205-366-9740
  • Fax: 205-344-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily
License NumberF06171960
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: