Provider Demographics
NPI:1578751046
Name:DELOSREYES, IMELDA FRANCISCO (DMD)
Entity Type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:FRANCISCO
Last Name:DELOSREYES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 CANARIOS CT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7877
Mailing Address - Country:US
Mailing Address - Phone:619-421-4570
Mailing Address - Fax:619-421-4554
Practice Address - Street 1:885 CANARIOS CT
Practice Address - Street 2:SUITE 212
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7877
Practice Address - Country:US
Practice Address - Phone:619-421-4570
Practice Address - Fax:619-421-4554
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA523701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice