Provider Demographics
NPI:1427028828
Name:DE LOS REYES, OCTAVIO (DO)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:
Last Name:DE LOS REYES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2128
Mailing Address - Country:US
Mailing Address - Phone:540-949-8121
Mailing Address - Fax:
Practice Address - Street 1:40 LAMBERT ST
Practice Address - Street 2:SUITE 522
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2446
Practice Address - Country:US
Practice Address - Phone:540-885-3525
Practice Address - Fax:540-886-5935
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102-200836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005640172Medicaid
F13097Medicare UPIN
080007117Medicare ID - Type Unspecified
VA80007117Medicare PIN