MEDICARE: DOLORES REYES FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP145585	TX

General Provider Information

NPI Number	:	1235758160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLORES REYES FNP-BC

Provider Business Mailing Address
First Line	:	6306 FAIRBANKS N HOUSTON RD STE 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-5193
Country	:	US
Telephone Number	:	832-831-9094
Fax Number	:	832-379-7446

Provider Business Practice Location Address
First Line	:	6306 FAIRBANKS N HOUSTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-5192
Country	:	US
Telephone Number	:	832-831-9094
Fax Number	:	832-379-7446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2020
Last Update Date	:	10/09/2022

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