Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | A40111 | CA |
NPI | 1174611206 |
---|---|
Provider Name | Norman David Reyes |
First Address | Sacramento, CA 95819-3624 |
Second Address | Sacramento, CA 95819-3624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 16/09/2013 |