Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 34.013452 | OH |
NPI | 1356617765 |
---|---|
Provider Name | Irma L Reyes |
First Address | Dayton, OH 45404-1873 |
Second Address | Dayton, OH 45404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 23/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0297669 | (05) | OH |