1609271865 NPI number — CONNIE JOANY REYES-PRECIADO BS, IBCLC

Table of content: CONNIE JOANY REYES-PRECIADO BS, IBCLC (NPI 1609271865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609271865 NPI number — CONNIE JOANY REYES-PRECIADO BS, IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES-PRECIADO
Provider First Name:
CONNIE
Provider Middle Name:
JOANY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS, IBCLC
Provider Gender Code:
F

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:
1609271865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12864 FOUR PALMS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLMAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91342-5800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-382-7689
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12864 FOUR PALMS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-5800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-382-7689
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2014

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: 174N00000X , with the licence number:  L-56501 , 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