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General NPI Number Information
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NPI Number | 1083187736
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Entity Type | Individual
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Provider Name | MARIA CASSANDRA REYES NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/05/2019
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Last Update Date | 09/01/2019
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Provider Practice Location Address
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Address Line | 4600 BROADWAY
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City | SACRAMENTO
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State | CA
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Zip | 95820-1527
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Country | US
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Telephone | 916-874-9670
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 BROADWAY
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City | SACRAMENTO
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State | CA
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Zip | 95820-1527
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Country | US
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Telephone | 916-874-9670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F12180873
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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