Provider Demographics
NPI:1508679119
Name:DELOS REYES, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DELOS REYES
Suffix:
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 1:5304 W GRACE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3336
Mailing Address - Country:US
Mailing Address - Phone:773-332-6933
Mailing Address - Fax:
Practice Address - Street 1:5304 W GRACE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3336
Practice Address - Country:US
Practice Address - Phone:773-332-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program