Provider Demographics
NPI:1972597474
Name:REINOSO, MAURICIO A (MD PA)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:A
Last Name:REINOSO
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16605 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3501
Mailing Address - Country:US
Mailing Address - Phone:281-980-1330
Mailing Address - Fax:281-980-1330
Practice Address - Street 1:16605 SOUTHWEST FWY
Practice Address - Street 2:SUITE 310
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3501
Practice Address - Country:US
Practice Address - Phone:281-980-1330
Practice Address - Fax:281-980-1330
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5877207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128603102Medicaid
TX8W6180OtherBLUE CROSS BLUE SHIELD
TX8W6180OtherBLUE CROSS BLUE SHIELD