Healthcare Provider Details

I. General information

NPI: 1184012072
Provider Name (Legal Business Name): REYNALDO M SY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: REYNALDO M SY REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35080 CHANDLER AVE SPC 68
CALIMESA CA
92320-1928
US

IV. Provider business mailing address

35080 CHANDLER AVE SPC 68
CALIMESA CA
92320-1928
US

V. Phone/Fax

Practice location:
  • Phone: 714-333-6615
  • Fax:
Mailing address:
  • Phone: 714-333-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number689257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: