Healthcare Provider Details

I. General information

NPI: 1477403392
Provider Name (Legal Business Name): SANDRA CECILIA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 D ST NE
WASHINGTON DC
20002-5507
US

IV. Provider business mailing address

250 RIPS DR
LOTHIAN MD
20711-9412
US

V. Phone/Fax

Practice location:
  • Phone: 202-709-0765
  • Fax:
Mailing address:
  • Phone: 240-533-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: