Healthcare Provider Details

I. General information

NPI: 1851215180
Provider Name (Legal Business Name): TATIANA CAROLINA REYES CMI CERTIFIED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12510 MACDUFF DR
FORT WASHINGTON MD
20744-6462
US

IV. Provider business mailing address

12510 MACDUFF DR
FORT WASHINGTON MD
20744-6462
US

V. Phone/Fax

Practice location:
  • Phone: 910-429-6051
  • Fax:
Mailing address:
  • Phone: 910-429-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number102635
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: