Provider Demographics
NPI:1588848725
Name:REY, FERNANDO ANDRES (DC)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ANDRES
Last Name:REY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 VAN NUYS BLVD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-2454
Mailing Address - Country:US
Mailing Address - Phone:818-894-4437
Mailing Address - Fax:818-894-6061
Practice Address - Street 1:8780 VAN NUYS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2412
Practice Address - Country:US
Practice Address - Phone:818-894-4437
Practice Address - Fax:818-894-6061
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27695111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 0276950Medicaid
CADC 0276950Medicaid