Provider Demographics
NPI:1841865227
Name:REEDY, RALPH (NBC-HWC)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:REEDY
Suffix:
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23892 BLUE RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23892 BLUE RIDGE PL
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-2924
Practice Address - Country:US
Practice Address - Phone:775-741-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date: