Provider Demographics
NPI:1326678608
Name:REYES, SAMANTHA (LVN)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-5627
Mailing Address - Country:US
Mailing Address - Phone:915-791-2047
Mailing Address - Fax:
Practice Address - Street 1:10824 MILLER BARBER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-2018
Practice Address - Country:US
Practice Address - Phone:915-791-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350934164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350934OtherTEXAS BOARD OF NURSING