Individual
MRS. NICOLE REYES BASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1410 MEDICAL PKWY, SUITE 1, CEDAR PARK, TX 78613-7464
(512) 260-3444
(512) 260-3555
Mailing address
1410 MEDICAL PKWY, SUITE 1, CEDAR PARK, TX 78613-7464
(512) 260-3444
(512) 260-3555
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M7029
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190366801
—
TX
01
—
8AQ401
BCBS TX
TX
Enumeration date
09/06/2006
Last updated
07/22/2024
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