Provider Demographics
NPI:1720382914
Name:REYES, ELVIRA REYES (CNIM, REPT)
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:REYES
Last Name:REYES
Suffix:
Gender:F
Credentials:CNIM, REPT
Other - Prefix:
Other - First Name:ELVIRA
Other - Middle Name:
Other - Last Name:REYES-ASHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNIM, REPT
Mailing Address - Street 1:1819 JAY ELL DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1837
Mailing Address - Country:US
Mailing Address - Phone:888-344-2947
Mailing Address - Fax:
Practice Address - Street 1:1819 JAY ELL DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1837
Practice Address - Country:US
Practice Address - Phone:888-344-2947
Practice Address - Fax:888-694-2947
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-02
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX987246ZE0600X
TX1989246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic