Provider Demographics
NPI:1013338482
Name:REYES, RICARDO JR
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:REYES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4918
Mailing Address - Country:US
Mailing Address - Phone:602-866-9378
Mailing Address - Fax:602-866-9394
Practice Address - Street 1:1208 E BROADWAY RD STE 215
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1512
Practice Address - Country:US
Practice Address - Phone:480-699-1233
Practice Address - Fax:480-907-7082
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator