Provider Demographics
NPI:1043532096
Name:REYES, ADELAIDA R (RD)
Entity Type:Individual
Prefix:MS
First Name:ADELAIDA
Middle Name:R
Last Name:REYES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2227
Mailing Address - Country:US
Mailing Address - Phone:276-236-1686
Mailing Address - Fax:276-236-1109
Practice Address - Street 1:200 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2227
Practice Address - Country:US
Practice Address - Phone:276-236-1686
Practice Address - Fax:276-236-1109
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
860748133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered