Healthcare Provider Details

I. General information

NPI: 1952036543
Provider Name (Legal Business Name): ALEXANDRA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11226 N 23RD AVE STE 101
PHOENIX AZ
85029-4830
US

IV. Provider business mailing address

12740 W INDIAN SCHOOL RD APT W206
LITCHFIELD PARK AZ
85340-6507
US

V. Phone/Fax

Practice location:
  • Phone: 602-794-7221
  • Fax:
Mailing address:
  • Phone: 928-287-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: