Provider Demographics
NPI:1275683633
Name:REYES, ANDY MARTINEZ
Entity Type:Individual
Prefix:MR
First Name:ANDY
Middle Name:MARTINEZ
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-5433
Mailing Address - Country:US
Mailing Address - Phone:239-839-1882
Mailing Address - Fax:239-369-5260
Practice Address - Street 1:1500 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4835
Practice Address - Country:US
Practice Address - Phone:239-368-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other