1972597474 NPI number — DR. MAURICIO A REINOSO MD PA

Table of content: DR. MAURICIO A REINOSO MD PA (NPI 1972597474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972597474 NPI number — DR. MAURICIO A REINOSO MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINOSO
Provider First Name:
MAURICIO
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972597474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16605 SOUTHWEST FWY
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-3501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-980-1330
Provider Business Mailing Address Fax Number:
281-980-1330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16605 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-980-1330
Provider Business Practice Location Address Fax Number:
281-980-1330
Provider Enumeration Date:
09/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  J5877 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X , with the licence number: J5877 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: J5877 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 128603102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8W6180 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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