Provider Demographics
NPI:1790722098
Name:REYES, YSABEL VIVIANA (MD)
Entity Type:Individual
Prefix:
First Name:YSABEL
Middle Name:VIVIANA
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 NOGALITOS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78225-1750
Mailing Address - Country:US
Mailing Address - Phone:210-436-8400
Mailing Address - Fax:833-452-1052
Practice Address - Street 1:2710 NOGALITOS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-1750
Practice Address - Country:US
Practice Address - Phone:210-436-8400
Practice Address - Fax:833-452-1052
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11812208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004256Medicaid
RI9004256Medicaid
I40580Medicare UPIN