Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | NM7587 | NM |
NPI | 1003825977 |
---|---|
Provider Name | Rebecca Reyes |
First Address | Fort Huachuca, AZ 85613-7079 |
Second Address | Fort Huachuca, AZ 85613-7079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 08/07/2007 |