Provider Demographics
NPI:1578691945
Name:REYES, ROBERT (CST)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S RANCHO DR
Mailing Address - Street 2:#107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4806
Mailing Address - Country:US
Mailing Address - Phone:702-878-8370
Mailing Address - Fax:702-259-1026
Practice Address - Street 1:600 S RANCHO DR
Practice Address - Street 2:#107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4806
Practice Address - Country:US
Practice Address - Phone:702-878-8370
Practice Address - Fax:702-259-1026
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV077829247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVB63336Medicare UPIN