Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | MD450781 | PA |
NPI | 1083813851 |
---|---|
Provider Name | Dr. Lilia Beatriz Reyes |
First Address | Hershey, PA 17033-2360 |
Second Address | Hershey, PA 17033-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 10/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
245125 | NEW YORK STATE LICENSE (01) | NY |