Provider Demographics
NPI:1083907547
Name:REYES, KENNETH BALDEMOR (RN)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BALDEMOR
Last Name:REYES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:438 CAMINO DEL RIO S STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:438 CAMINO DEL RIO S STE 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3546
Practice Address - Country:US
Practice Address - Phone:619-955-8507
Practice Address - Fax:619-955-8508
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95043997163W00000X
CA223137164X00000X
CA95018998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse