Provider Demographics
NPI:1184012072
Name:SY, REYNALDO M
Entity Type:Individual
Prefix:
First Name:REYNALDO
Middle Name:M
Last Name:SY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:REYNALDO
Other - Middle Name:M
Other - Last Name:SY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:35080 CHANDLER AVE SPC 68
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-1928
Mailing Address - Country:US
Mailing Address - Phone:714-333-6615
Mailing Address - Fax:
Practice Address - Street 1:35080 CHANDLER AVE SPC 68
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1928
Practice Address - Country:US
Practice Address - Phone:714-333-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA689257163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy