Healthcare Provider Details

I. General information

NPI: 1669182051
Provider Name (Legal Business Name): JASMINE YVETTE REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 MURCHISON DR STE 100
EL PASO TX
79902-4821
US

IV. Provider business mailing address

13216 BYWELL
HORIZON CITY TX
79928-2110
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1088821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: