Provider Demographics
NPI:1871271528
Name:REYES, MADELINE GABRIELA
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:GABRIELA
Last Name:REYES
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 1:8622 N LOOP DR APT 7002
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-4546
Mailing Address - Country:US
Mailing Address - Phone:915-422-9386
Mailing Address - Fax:
Practice Address - Street 1:8622 N LOOP DR APT 7002
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-4546
Practice Address - Country:US
Practice Address - Phone:915-422-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician