Provider Demographics
NPI:1023788213
Name:REYNOSO, MARYCHRIS M
Entity type:Individual
Prefix:
First Name:MARYCHRIS
Middle Name:M
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6646 DESIREE LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2229
Mailing Address - Country:US
Mailing Address - Phone:907-310-7584
Mailing Address - Fax:
Practice Address - Street 1:1825 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5391
Practice Address - Country:US
Practice Address - Phone:907-522-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program