Provider Demographics
NPI:1669412748
Name:REYES, PABLO (APRN BC FNP CNS)
Entity type:Individual
Prefix:MR
First Name:PABLO
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:APRN BC FNP CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11661 JOHN WEIR DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0707
Mailing Address - Country:US
Mailing Address - Phone:915-855-6167
Mailing Address - Fax:
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:WBAMC
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-569-1382
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551796363LF0000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health