Basic Information
Provider Information | |||||||||
NPI: | 1164989919 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | REYES GAURANO | ||||||||
FirstName: | VALERIE | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHARM.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | REYES | ||||||||
OtherFirstName: | VALERIE | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1601 PRECISION PARK LN | ||||||||
Address2: |   | ||||||||
City: | SAN DIEGO | ||||||||
State: | CA | ||||||||
PostalCode: | 921731345 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6192056349 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4004 BEYER BLVD | ||||||||
Address2: |   | ||||||||
City: | SAN YSIDRO | ||||||||
State: | CA | ||||||||
PostalCode: | 921732099 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6199142356 | ||||||||
FaxNumber: | 6194284761 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/28/2019 | ||||||||
LastUpdateDate: | 02/28/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH38852 | CA | Y |   | Pharmacy Service Providers | Pharmacist |   |
No ID Information.