Healthcare Provider Details

I. General information

NPI: 1306603121
Provider Name (Legal Business Name): ELIZABETH REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 E LOHMAN AVE STE B
LAS CRUCES NM
88011-8268
US

IV. Provider business mailing address

7338 BLACK MESA DR
EL PASO TX
79911-3097
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number78085
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: