Provider Demographics
NPI:1417211996
Name:REYES, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
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 1:8930 W SUNSET RD STE 350
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5042
Mailing Address - Country:US
Mailing Address - Phone:702-389-5360
Mailing Address - Fax:702-570-1403
Practice Address - Street 1:8930 W SUNSET RD STE 350
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5042
Practice Address - Country:US
Practice Address - Phone:702-389-5360
Practice Address - Fax:702-570-1403
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2011213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV111584Medicare PIN