Provider Demographics
NPI:1013363514
Name:REYES, LUCIA FERNANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:FERNANDA
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ASHVILLE AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6130
Mailing Address - Country:US
Mailing Address - Phone:919-235-6575
Mailing Address - Fax:
Practice Address - Street 1:222 ASHVILLE AVE STE 10
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6130
Practice Address - Country:US
Practice Address - Phone:919-350-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC218223207Q00000X
FLME140690207Q00000X
NC2020-03475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103357200Medicaid