Healthcare Provider Details

I. General information

NPI: 1285723254
Provider Name (Legal Business Name): NORMAN DAVID REYES MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 J ST SUITE 368
SACRAMENTO CA
95819-3624
US

IV. Provider business mailing address

3941 J ST SUITE 368
SACRAMENTO CA
95819-3624
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-6840
  • Fax: 916-733-6980
Mailing address:
  • Phone: 916-733-6840
  • Fax: 916-733-6980

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: DR. NORMAN DAVID REYES
Title or Position: CEO
Credential: M.D.
Phone: 916-733-6840