Provider Demographics
NPI:1285723254
Name:NORMAN DAVID REYES MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NORMAN DAVID REYES MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-733-6840
Mailing Address - Street 1:3941 J ST
Mailing Address - Street 2:SUITE 368
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3624
Mailing Address - Country:US
Mailing Address - Phone:916-733-6840
Mailing Address - Fax:916-733-6980
Practice Address - Street 1:3941 J ST
Practice Address - Street 2:SUITE 368
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3624
Practice Address - Country:US
Practice Address - Phone:916-733-6840
Practice Address - Fax:916-733-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA401112086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401110Medicaid