Basic Information
Provider Information
NPI: 1538452131
EntityType: 2
ReplacementNPI:  
OrganizationName: ADRIAN V REYES MD INC
LastName:  
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Mailing Information
Address1: PO BOX 788
Address2:  
City: HEMET
State: CA
PostalCode: 925460788
CountryCode: US
TelephoneNumber: 9519296260
FaxNumber: 9517652855
Practice Location
Address1: 1805 MEDICAL CENTER DR
Address2:  
City: SAN BERNARDINO
State: CA
PostalCode: 924111217
CountryCode: US
TelephoneNumber: 9098876333
FaxNumber: 9098061079
Other Information
ProviderEnumerationDate: 05/16/2011
LastUpdateDate: 04/09/2014
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: REYES
AuthorizedOfficialFirstName: ADRIAN
AuthorizedOfficialMiddleName: V
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 9519296260
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XA51386CAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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