1386287613 NPI number — MR. JOSELEO R. DELOS REYES PTA

Table of content: MR. JOSELEO R. DELOS REYES PTA (NPI 1386287613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386287613 NPI number — MR. JOSELEO R. DELOS REYES PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELOS REYES
Provider First Name:
JOSELEO
Provider Middle Name:
R.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PTA
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:
1386287613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9663
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96931-5663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-649-8746
Provider Business Mailing Address Fax Number:
671-647-1606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
396 CHALAN SAN ANTONIO BRI BLDG.
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TAMUNING
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96913-5663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-649-8746
Provider Business Practice Location Address Fax Number:
671-647-1606
Provider Enumeration Date:
10/18/2019

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: 225200000X , with the licence number:  PTA-09 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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