1326471202 NPI number — DR. GRACIELA BELLANEY REYES M.D.

Table of content: DR. GRACIELA BELLANEY REYES M.D. (NPI 1326471202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326471202 NPI number — DR. GRACIELA BELLANEY REYES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES
Provider First Name:
GRACIELA
Provider Middle Name:
BELLANEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOBERT
Provider Other First Name:
GRACIELA
Provider Other Middle Name:
BELLANEY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326471202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 CANYON LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57702-8114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-355-2500
Provider Business Mailing Address Fax Number:
605-355-2403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4269 NW 88TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33351-6044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-578-0200
Provider Business Practice Location Address Fax Number:
954-578-0050
Provider Enumeration Date:
08/15/2013

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: 208D00000X , with the licence number:  18558 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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