Healthcare Provider Details

I. General information

NPI: 1174611206
Provider Name (Legal Business Name): NORMAN DAVID REYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 UNIVERSITY AVENUE SUITE 120
SACRAMENTO CA
95825-6532
US

IV. Provider business mailing address

333 UNIVERSITY AVENUE SUITE 120
SACRAMENTO CA
95825-6532
US

V. Phone/Fax

Practice location:
  • Phone: 916-929-8564
  • Fax: 916-929-5963
Mailing address:
  • Phone: 916-929-8564
  • Fax: 916-929-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA40111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: