Healthcare Provider Details

I. General information

NPI: 1780297283
Provider Name (Legal Business Name): OSCAR MACIEL REYES DNP, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 10/13/2023
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E BASELINE RD STE 5
PHOENIX AZ
85042-6536
US

IV. Provider business mailing address

3101 N CENTRAL AVE STE 550
PHOENIX AZ
85012-2635
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-7373
  • Fax: 602-441-5836
Mailing address:
  • Phone: 602-230-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number246688
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: