Provider Demographics
NPI:1316399504
Name:REYES, JOSE GUADALUPE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:GUADALUPE
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 N CONWAY AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2926
Mailing Address - Country:US
Mailing Address - Phone:956-580-4040
Mailing Address - Fax:956-580-4915
Practice Address - Street 1:2002 N CONWAY AVE STE F
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2926
Practice Address - Country:US
Practice Address - Phone:956-580-4040
Practice Address - Fax:956-580-4915
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214032224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant