Basic Information
| Provider Information | |||||||||
| NPI: | 1649335332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REY | ||||||||
| FirstName: | GLORIA | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 883 REEDMERE | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | N8S2L6 | ||||||||
| CountryCode: | CA | ||||||||
| TelephoneNumber: | 2158844503 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7733 E JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482143707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134994900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601004802 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.