Healthcare Provider Details

I. General information

NPI: 1396385795
Provider Name (Legal Business Name): DANIEL MICHAEL REYES CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 S FAIR OAKS AVE
PASADENA CA
91105-2625
US

IV. Provider business mailing address

2900 N ROCKY POINT DR
TAMPA FL
33607-1435
US

V. Phone/Fax

Practice location:
  • Phone: 213-368-3374
  • Fax: 213-639-3454
Mailing address:
  • Phone: 813-518-7832
  • Fax: 813-518-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO03852
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: