Provider Demographics
NPI:1225462401
Name:REYES-DAVID, FEMINA GRACE BASCO (RN, MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:FEMINA GRACE
Middle Name:BASCO
Last Name:REYES-DAVID
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8337 HANDEL DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3116
Mailing Address - Country:US
Mailing Address - Phone:714-735-9151
Mailing Address - Fax:714-735-9151
Practice Address - Street 1:8337 HANDEL DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3116
Practice Address - Country:US
Practice Address - Phone:714-735-9151
Practice Address - Fax:714-735-9151
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23568363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily