1457048407 NPI number — MS. GABRIELA REDA CHES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457048407 NPI number — MS. GABRIELA REDA CHES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDA
Provider First Name:
GABRIELA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CHES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOEDECKER
Provider Other First Name:
GABRIELA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457048407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 PALISADES CIRCLE
Provider Second Line Business Mailing Address:
APT 7406
Provider Business Mailing Address City Name:
MANASSAS PARK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-826-0183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 PALISADES CIRCLE
Provider Second Line Business Practice Location Address:
APT 7406
Provider Business Practice Location Address City Name:
MANASSAS PARK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-826-0183
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2023

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: 174H00000X , with the licence number:  34127 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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