MEDICARE: ROSELVIRA REYES

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1942036348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELVIRA REYES

Provider Business Mailing Address
First Line	:	PO BOX 250
Second Line	:
City	:	FABENS
State	:	TX
Zip	:	79838-0250
Country	:	US
Telephone Number	:	915-603-9224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-3504
Country	:	US
Telephone Number	:	915-286-6370
Fax Number	:

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

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	09/11/2024

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Directions to “ ROSELVIRA REYES ” Practice Location

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