Provider Demographics
NPI:1407473051
Name:REYES, ELIA
Entity Type:Individual
Prefix:
First Name:ELIA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIA
Other - Middle Name:I
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5208 BLOSSOM AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142
Mailing Address - Country:US
Mailing Address - Phone:702-741-3007
Mailing Address - Fax:
Practice Address - Street 1:5208 BLOSSOM AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142
Practice Address - Country:US
Practice Address - Phone:702-741-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant