Provider Demographics
NPI:1861859928
Name:REY, JENNIFER (BOCO)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:REY
Suffix:
Gender:F
Credentials:BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 E BIDWELL ST
Mailing Address - Street 2:HANGER CLINIC
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-984-5606
Mailing Address - Fax:916-984-8568
Practice Address - Street 1:2575 E BIDWELL ST, STE 200
Practice Address - Street 2:HANGER CLINIC
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-984-5606
Practice Address - Fax:916-984-8568
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC51500222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932273810Medicare UPIN