Provider Demographics
NPI:1194866103
Name:EAGLES, REBA I (D O M)
Entity Type:Individual
Prefix:DR
First Name:REBA
Middle Name:I
Last Name:EAGLES
Suffix:
Gender:F
Credentials:D O M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 11TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1808
Mailing Address - Country:US
Mailing Address - Phone:505-604-3434
Mailing Address - Fax:505-242-2410
Practice Address - Street 1:119 SAN PASQUALE AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1153
Practice Address - Country:US
Practice Address - Phone:505-604-3434
Practice Address - Fax:505-242-2410
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM833171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist