=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285723254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORMAN DAVID REYES MD A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 01/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3941 J ST SUITE 368
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95819-3624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-733-6840
-----------------------------------------------------
Fax | 916-733-6980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3941 J ST SUITE 368
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95819-3624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-733-6840
-----------------------------------------------------
Fax | 916-733-6980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. NORMAN DAVID REYES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 916-733-6840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | A40111
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------