Healthcare Provider Details

I. General information

NPI: 1558750208
Provider Name (Legal Business Name): DIANA CAROLINA REYES C.P.M, L.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 S 3RD AVE
TUCSON AZ
85714-1522
US

IV. Provider business mailing address

304 12TH AVE RD
NAMPA ID
83686-5015
US

V. Phone/Fax

Practice location:
  • Phone: 505-489-1482
  • Fax:
Mailing address:
  • Phone: 505-489-1482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number5571698
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: