Healthcare Provider Details

I. General information

NPI: 1407628647
Provider Name (Legal Business Name): RICA REUYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 UNIVERSITY DR
VIRGINIA BEACH VA
23453-8083
US

IV. Provider business mailing address

1961 SUN VALLEY DR
VIRGINIA BEACH VA
23464-7443
US

V. Phone/Fax

Practice location:
  • Phone: 757-683-4297
  • Fax:
Mailing address:
  • Phone: 175-738-9139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number154262
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001259967
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: