Individual
EMILY MEGAN REYNOSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 926-2544
Mailing address
1724 ROCK VIEW CT, FORT WORTH, TX 76112-3712
(254) 652-8411
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
147543
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
1149010
TX
Other
Enumeration date
01/08/2024
Last updated
06/18/2024
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