Provider Demographics
NPI:1083289763
Name:REYES, FREDY
Entity Type:Individual
Prefix:
First Name:FREDY
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 BUTTON BUSH CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3349
Mailing Address - Country:US
Mailing Address - Phone:202-560-0555
Mailing Address - Fax:
Practice Address - Street 1:5924 16TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2862
Practice Address - Country:US
Practice Address - Phone:202-560-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000605862376K00000X
DCE3131816146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate