Provider Demographics
NPI:1699085829
Name:REYES, JADA YMOLIA
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:YMOLIA
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 1:2001 RAMROD AVE APT 321
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2380
Mailing Address - Country:US
Mailing Address - Phone:973-510-4247
Mailing Address - Fax:
Practice Address - Street 1:2001 RAMROD AVE APT 321
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2380
Practice Address - Country:US
Practice Address - Phone:973-510-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner