Healthcare Provider Details

I. General information

NPI: 1508792763
Provider Name (Legal Business Name): SARA LETICIA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4412 BERRYKNOLL DR
COLORADO SPRINGS CO
80916-3312
US

IV. Provider business mailing address

4412 BERRYKNOLL DR
COLORADO SPRINGS CO
80916-3312
US

V. Phone/Fax

Practice location:
  • Phone: 719-271-3352
  • Fax:
Mailing address:
  • Phone: 719-271-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: