Provider Demographics
NPI:1760679872
Name:REYES, SANTA LISA
Entity Type:Individual
Prefix:
First Name:SANTA
Middle Name:LISA
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 1:3950 RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-3257
Mailing Address - Country:US
Mailing Address - Phone:916-648-0980
Mailing Address - Fax:
Practice Address - Street 1:3950 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3257
Practice Address - Country:US
Practice Address - Phone:916-648-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide