Healthcare Provider Details

I. General information

NPI: 1043288715
Provider Name (Legal Business Name): BAYANI BELEN DE LOS REYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 INDEPENDENCE AVE
MARION OH
43302-6317
US

IV. Provider business mailing address

1167 INDEPENDENCE AVE
MARION OH
43302-6317
US

V. Phone/Fax

Practice location:
  • Phone: 740-382-8200
  • Fax: 740-389-6241
Mailing address:
  • Phone: 740-382-8200
  • Fax: 740-389-6241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35045847
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: