Provider Demographics
NPI:1467010512
Name:REYES, LESVIA CASTILLO
Entity Type:Individual
Prefix:
First Name:LESVIA
Middle Name:CASTILLO
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 HOLLY OAK ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-5805
Mailing Address - Country:US
Mailing Address - Phone:936-645-0910
Mailing Address - Fax:
Practice Address - Street 1:914 HOLLY OAK ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-5805
Practice Address - Country:US
Practice Address - Phone:936-645-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332476164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse