Provider Demographics
NPI:1376753467
Name:REYES, ENRIQUE LANDINO (RN)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:LANDINO
Last Name:REYES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 INNOVATOR DR APT 1302
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3868
Mailing Address - Country:US
Mailing Address - Phone:916-830-1527
Mailing Address - Fax:916-830-1861
Practice Address - Street 1:4101 INNOVATOR DR APT 1302
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3868
Practice Address - Country:US
Practice Address - Phone:916-830-1527
Practice Address - Fax:916-830-1861
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse