Provider Demographics
NPI:1841302049
Name:REYES, LEONEL (MD)
Entity type:Individual
Prefix:
First Name:LEONEL
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 CAMDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1925
Mailing Address - Country:US
Mailing Address - Phone:210-224-9918
Mailing Address - Fax:210-224-9924
Practice Address - Street 1:515 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1925
Practice Address - Country:US
Practice Address - Phone:210-224-9918
Practice Address - Fax:210-224-9924
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131542605Medicaid
TX742784179OtherTAX ID NUMBER
TX742784179OtherTAX ID NUMBER
TX131542605Medicaid