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General NPI Number Information
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NPI Number | 1891946786
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Entity Type | Organization
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Legal Business Name | DR CARLOS REYES-PESCADOR
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 1000 ENGLISH RD BLUE BONNET ESTATES
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City | ROCKWALL
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State | TX
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Zip | 75032-8288
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Country | US
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Telephone | 972-524-5617
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Fax | 972-524-1035
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Provider Business Mailing Address
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Address Line | 1800 N GALLOWAY AVE SUITE # 100
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City | MESQUITE
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State | TX
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Zip | 75149-2299
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Country | US
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Telephone | 972-279-1700
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Fax | 971-279-1102
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARLOS REYES-PESCADOR
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Credential | MD
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Telephone | 972-279-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G4693
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License Number State | TX
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