Healthcare Provider Details

I. General information

NPI: 1417916594
Provider Name (Legal Business Name): JOEL A REYES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2006
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 ALAMEDA AVE PEDIATRIC ICU - 10TH FLOOR
EL PASO TX
79905-2705
US

IV. Provider business mailing address

4845 ALAMEDA AVE PEDIATRIC ICU - 10TH FLOOR
EL PASO TX
79905-2705
US

V. Phone/Fax

Practice location:
  • Phone: 915-298-5431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101016314
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberM6359
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: