Provider Demographics
NPI:1750115879
Name:REYES, BRANDON XAVIER
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:XAVIER
Last Name: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 1:1841 MARROSE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1553
Mailing Address - Country:US
Mailing Address - Phone:614-824-0438
Mailing Address - Fax:
Practice Address - Street 1:1841 MARROSE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1553
Practice Address - Country:US
Practice Address - Phone:614-824-0438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide