1467752659 NPI number — CYNTHIA M. DE LOS REYES, MD, PLLC

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 1467752659 NPI number — CYNTHIA M. DE LOS REYES, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYNTHIA M. DE LOS REYES, MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1467752659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
923 SOUTH AUBURN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-582-3571
Provider Business Mailing Address Fax Number:
509-586-4383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
923 SOUTH AUBURN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-582-3571
Provider Business Practice Location Address Fax Number:
509-586-4383
Provider Enumeration Date:
10/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DE LOS REYES
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
MARCELO
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
509-582-3571

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  602094837 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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