Provider Demographics
NPI:1326471202
Name:REYES, GRACIELA BELLANEY (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACIELA
Middle Name:BELLANEY
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GRACIELA
Other - Middle Name:BELLANEY
Other - Last Name:HOBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3200 CANYON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8114
Mailing Address - Country:US
Mailing Address - Phone:605-355-2500
Mailing Address - Fax:605-355-2403
Practice Address - Street 1:4269 NW 88TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6044
Practice Address - Country:US
Practice Address - Phone:954-578-0200
Practice Address - Fax:954-578-0050
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18558208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice