Healthcare Provider Details

I. General information

NPI: 1174936207
Provider Name (Legal Business Name): REY AGATEP D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 PINE AVE
TRUCKEE CA
96161-4856
US

IV. Provider business mailing address

10121 PINE AVE
TRUCKEE CA
96161-4856
US

V. Phone/Fax

Practice location:
  • Phone: 530-582-6627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP60666398
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO2818
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: