Provider Demographics
NPI:1285349043
Name:REYES, SAMANTHA VICTORIA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:VICTORIA
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 MORRO BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2108
Mailing Address - Country:US
Mailing Address - Phone:757-214-5159
Mailing Address - Fax:
Practice Address - Street 1:4804 MORRO BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2108
Practice Address - Country:US
Practice Address - Phone:757-214-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program