Provider Demographics
NPI:1104497817
Name:DELOS REYES, RANIER SELORIO
Entity type:Individual
Prefix:
First Name:RANIER
Middle Name:SELORIO
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 1:5001 SAINT MATTHEWS DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-5183
Mailing Address - Country:US
Mailing Address - Phone:240-533-1444
Mailing Address - Fax:
Practice Address - Street 1:5001 SAINT MATTHEWS DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-5183
Practice Address - Country:US
Practice Address - Phone:240-533-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-03
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1017208363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty