1043669815 NPI number — DR. EDGAR REYES GARCIA DDS

Table of content: DR. EDGAR REYES GARCIA DDS (NPI 1043669815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043669815 NPI number — DR. EDGAR REYES GARCIA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES GARCIA
Provider First Name:
EDGAR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1043669815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1611 S MELROSE DR, SUITE A
Provider Second Line Business Mailing Address:
#257
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92081-5407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-568-5782
Provider Business Mailing Address Fax Number:
760-598-6034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1631 S MELROSE DR STE I
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92081-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-598-7565
Provider Business Practice Location Address Fax Number:
760-598-6034
Provider Enumeration Date:
06/12/2016

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: 122300000X , with the licence number:  100278 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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