Basic Information
| Provider Information | |||||||||
| NPI: | 1275517583 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 W GROVE ST | ||||||||
| Address2: | STE 120 | ||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751421882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729321319 | ||||||||
| FaxNumber: | 9729321396 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 W GROVE ST | ||||||||
| Address2: | |||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751421882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729321319 | ||||||||
| FaxNumber: | 9729321396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G0006 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 139455304 | 05 | TX | MEDICAID | 139455306 | 05 | TX | MEDICAID | 139455313 | 05 | TX | MEDICAID | 139455302 | 05 | TX | MEDICAID | 139455316 | 05 | TX | MEDICAID | 139455301 | 05 | TX | MEDICAID | 139455305 | 05 | TX | MEDICAID | 139455318 | 05 | TX | MEDICAID | 8AL501 | 01 | TX | BCBS | OTHER | 139455307 | 05 | TX | MEDICAID | 139455311 | 05 | TX | MEDICAID | 139455308 | 05 | TX | MEDICAID | 139455315 | 05 | TX | MEDICAID | 139455309 | 05 | TX | MEDICAID |