Provider Demographics
NPI:1467002758
Name:REYES, SHAILA SIMBULAN
Entity Type:Individual
Prefix:MS
First Name:SHAILA
Middle Name:SIMBULAN
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 S WOODMAN ST APT 39
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-1262
Mailing Address - Country:US
Mailing Address - Phone:619-577-8798
Mailing Address - Fax:
Practice Address - Street 1:6441 LA JOLLA SCENIC DR S
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-6446
Practice Address - Country:US
Practice Address - Phone:858-454-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF2633870OtherDRIVER LICENSE