Healthcare Provider Details

I. General information

NPI: 1083187736
Provider Name (Legal Business Name): MARIA CASSANDRA REYES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2019
Last Update Date: 09/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY
SACRAMENTO CA
95820-1527
US

IV. Provider business mailing address

4600 BROADWAY
SACRAMENTO CA
95820-1527
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-9670
  • Fax:
Mailing address:
  • Phone: 916-874-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12180873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: