Basic Information
| Provider Information | |||||||||
| NPI: | 1457650640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | KRISTINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SAN VALENTIN | ||||||||
| OtherFirstName: | MARIA KRISTINE | ||||||||
| OtherMiddleName: | REYES | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6621 FANNIN ST | ||||||||
| Address2: | SUITE W6104 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328261380 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6621 FANNIN ST | ||||||||
| Address2: | SUITE W6104 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328261380 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2011 | ||||||||
| LastUpdateDate: | 01/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | BP10037380 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.