Provider Demographics
NPI:1154622348
Name:REYES, RONALD GUMAMIT (N/A)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:GUMAMIT
Last Name:REYES
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:12707 SE 42ND ST.APT.B1
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1970
Mailing Address - Country:US
Mailing Address - Phone:425-401-1353
Mailing Address - Fax:425-401-1353
Practice Address - Street 1:12707 SE 42ND ST APT B1
Practice Address - Street 2:12707 SE 42ND ST. APT B1
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1970
Practice Address - Country:US
Practice Address - Phone:425-401-1353
Practice Address - Fax:425-401-1353
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603 054 754332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies