Provider Demographics
NPI:1154364438
Name:REYES, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROSSI CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-2358
Mailing Address - Country:US
Mailing Address - Phone:831-757-4444
Mailing Address - Fax:831-757-4419
Practice Address - Street 1:591 MCCRAY ST STE 101
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023
Practice Address - Country:US
Practice Address - Phone:831-634-4444
Practice Address - Fax:831-634-4440
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52992207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A529920Medicaid
CA00A529920Medicaid
F75543Medicare UPIN
CA00A529925Medicare PIN