Healthcare Provider Details

I. General information

NPI: 1952230450
Provider Name (Legal Business Name): MARISSA ISELA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 S 60TH ST
OMAHA NE
68106-2151
US

IV. Provider business mailing address

1807 S 60TH ST
OMAHA NE
68106-2151
US

V. Phone/Fax

Practice location:
  • Phone: 531-299-1081
  • Fax: 531-299-1099
Mailing address:
  • Phone: 531-299-1081
  • Fax: 531-299-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: