Provider Demographics
NPI:1467526558
Name:REYES, MARIA THERESA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:THERESA
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6952 E BROADWAY
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208
Mailing Address - Country:US
Mailing Address - Phone:480-325-0905
Mailing Address - Fax:480-325-6661
Practice Address - Street 1:6952 E BROADWAY
Practice Address - Street 2:SUITE #101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208
Practice Address - Country:US
Practice Address - Phone:480-325-0905
Practice Address - Fax:480-325-6661
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ60336Medicare ID - Type Unspecified
G23489Medicare UPIN