Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95009706 | CA |
NPI | 1235696584 |
---|---|
Provider Name | Enrique Reyes Ayalde JR. |
First Address | San Francisco, CA 94107-2321 |
Second Address | San Francisco, CA 94110-4403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2019 |
Last Update Date | 22/02/2019 |