Provider Demographics
NPI:1144645862
Name:REYES, MIGUEL (PHD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 CROSSROADS CIR UNIT 424
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2975
Mailing Address - Country:US
Mailing Address - Phone:909-268-2740
Mailing Address - Fax:
Practice Address - Street 1:11550 CROSSROADS CIR UNIT 424
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-2975
Practice Address - Country:US
Practice Address - Phone:909-268-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist