Provider Demographics
NPI:1922196757
Name:REYES, RAQUEL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:R
Last Name:REYES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8590 RIO SAN DIEGO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5597
Mailing Address - Country:US
Mailing Address - Phone:619-299-1122
Mailing Address - Fax:619-299-1163
Practice Address - Street 1:8590 RIO SAN DIEGO DR STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5597
Practice Address - Country:US
Practice Address - Phone:619-299-1122
Practice Address - Fax:619-299-1163
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice