Provider Demographics
NPI:1750328969
Name:ALEJANDRO REYES, MARESSA M (MD)
Entity type:Individual
Prefix:
First Name:MARESSA
Middle Name:M
Last Name:ALEJANDRO 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 1:5216 NORTH SABINO HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:SC
Mailing Address - Zip Code:85749
Mailing Address - Country:US
Mailing Address - Phone:520-749-3031
Mailing Address - Fax:240-252-5668
Practice Address - Street 1:1702 W. ANKLAM ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-749-3031
Practice Address - Fax:240-252-5668
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30222207RG0300X
AZ43530207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ578519Medicaid
AZ578519Medicaid
AA2069Medicare PIN
H59622Medicare UPIN