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General NPI Number Information
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NPI Number | 1023093929
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Entity Type | Individual
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Provider Name | RICHARD WILLIAM REIS CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 400 NORTH PEPPER AVENUE 2ND FLOOR, ANESTHESIA DEPT. INLAND EMPIRE ANESTHESIA MEDICAL GROUP, INC.
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City | COLTON
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State | CA
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Zip | 92324-0765
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Country | US
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Telephone | 909-580-2440
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Fax | 909-580-2441
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Provider Business Mailing Address
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Address Line | PO BOX 765
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City | COLTON
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State | CA
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Zip | 92324-0800
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Country | US
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Telephone | 909-889-7084
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Fax | 909-889-7034
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NA716
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | NA716
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License Number State | CA
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