Provider Demographics
NPI:1992160121
Name:REYES, RYAN EDUARDO
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:EDUARDO
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 1ST ST STE 250
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1574
Mailing Address - Country:US
Mailing Address - Phone:800-785-8953
Mailing Address - Fax:303-922-4640
Practice Address - Street 1:2655 1ST ST STE 250
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1574
Practice Address - Country:US
Practice Address - Phone:800-785-8953
Practice Address - Fax:303-922-4640
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
246ZE0600XOtherSPECIALIST/TECHNOLOGIS. OTHER - ELECTRONEURODIAGNOSTIC