MEDICARE: MRS. MARIA VICTORIA REYNOLDS

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1538232079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA VICTORIA REYNOLDS

Provider Business Mailing Address
First Line	:	2608 S QUITMAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-5724
Country	:	US
Telephone Number	:	303-934-9265
Fax Number	:

Provider Business Practice Location Address
First Line	:	2608 S QUITMAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-5724
Country	:	US
Telephone Number	:	303-934-9265
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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