1437219052 NPI number — DR. PHILLIP C REYES D.C.

Table of content: DR. PHILLIP C REYES D.C. (NPI 1437219052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437219052 NPI number — DR. PHILLIP C REYES D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES
Provider First Name:
PHILLIP
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1437219052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2059 CLINTON AVE
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
ALAMEDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94501-4379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-865-1355
Provider Business Mailing Address Fax Number:
510-764-4912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2059 CLINTON AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-4379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-865-1355
Provider Business Practice Location Address Fax Number:
510-764-4912
Provider Enumeration Date:
12/12/2006

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: 111NS0005X , with the licence number:  DC 19954 , 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)





Copyright © 2007-2025 www.npivalidator.com