Healthcare Provider Details

I. General information

NPI: 1619260064
Provider Name (Legal Business Name): REYES ISMAEL CUEVAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 NORTHRISE DR STE A
LAS CRUCES NM
88011-6839
US

IV. Provider business mailing address

3485 NORTHRISE DR STE A
LAS CRUCES NM
88011-6839
US

V. Phone/Fax

Practice location:
  • Phone: 575-382-2149
  • Fax: 575-382-2187
Mailing address:
  • Phone: 575-382-2149
  • Fax: 575-382-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2015-0201
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: