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General NPI Number Information
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NPI Number | 1083907547
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Entity Type | Individual
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Provider Name | KENNETH BALDEMOR REYES FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 438 CAMINO DEL RIO S STE 203
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City | SAN DIEGO
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State | CA
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Zip | 92108-3546
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Country | US
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Telephone | 619-955-8507
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Fax | 619-955-8508
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Provider Business Mailing Address
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Address Line | 438 CAMINO DEL RIO S STE 203
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City | SAN DIEGO
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State | CA
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Zip | 92108-3546
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95018998
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95043997
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 223137
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License Number State | CA
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