1659449221 NPI number — MR. EDMOND CHAN REYES INDEPENDENT CORPSMAN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659449221 NPI number — MR. EDMOND CHAN REYES INDEPENDENT CORPSMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES
Provider First Name:
EDMOND
Provider Middle Name:
CHAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
INDEPENDENT CORPSMAN
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:
1659449221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35755 CORAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-852-8530
Provider Business Mailing Address Fax Number:
619-767-1497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL AIR STATION NORTH ISLAND
Provider Second Line Business Practice Location Address:
BLDG 290
Provider Business Practice Location Address City Name:
SANDIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-767-1496
Provider Business Practice Location Address Fax Number:
619-767-1497
Provider Enumeration Date:
12/01/2006

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: 171000000X , 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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