Healthcare Provider Details

I. General information

NPI: 1356482046
Provider Name (Legal Business Name): CARLA LOUISA O REYES MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N 30TH ST
OMAHA NE
68131-2100
US

IV. Provider business mailing address

555 N 30TH ST
OMAHA NE
68131-2136
US

V. Phone/Fax

Practice location:
  • Phone: 402-452-5000
  • Fax: 402-452-5028
Mailing address:
  • Phone: 402-280-8100
  • Fax: 402-280-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number233
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number233
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: