Provider Demographics
NPI:1821239583
Name:REYES-GUERRERO, EDNA I (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:I
Last Name:REYES-GUERRERO
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:3692 E SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3137
Mailing Address - Country:US
Mailing Address - Phone:713-946-1500
Mailing Address - Fax:713-946-0200
Practice Address - Street 1:3692 E SAM HOUSTON PKWY S
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3137
Practice Address - Country:US
Practice Address - Phone:713-946-1500
Practice Address - Fax:713-946-0200
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1943213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216266101Medicaid
TXTXB109393Medicare PIN