Provider Demographics
NPI:1033418587
Name:REYES, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 LESSONA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-0473
Mailing Address - Country:US
Mailing Address - Phone:702-685-3459
Mailing Address - Fax:702-851-8528
Practice Address - Street 1:10605 LESSONA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-0473
Practice Address - Country:US
Practice Address - Phone:702-685-3459
Practice Address - Fax:702-851-8528
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner