Provider Demographics
NPI:1972388890
Name:BANDA, REYES III (RD)
Entity type:Individual
Prefix:MR
First Name:REYES
Middle Name:
Last Name:BANDA
Suffix:III
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 SAILFISH AVE
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-7019
Mailing Address - Country:US
Mailing Address - Phone:956-212-8039
Mailing Address - Fax:
Practice Address - Street 1:2408 SAILFISH AVE
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-7019
Practice Address - Country:US
Practice Address - Phone:956-212-8039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86290759133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered