Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033418587 |
---|---|
Provider Name | Angela Reyes |
First Address | Las Vegas, NV 89141-0473 |
Second Address | Las Vegas, NV 89141-0473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2011 |
Last Update Date | 31/07/2014 |