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General NPI Number Information
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NPI Number | 1487207510
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Entity Type | Individual
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Provider Name | BRANDON REYES COLIN
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Gender | Male
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 2440 RIVER RD STE 140
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City | NORCO
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State | CA
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Zip | 92860-2402
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Country | US
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Telephone | 951-225-1783
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Fax |
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Provider Business Mailing Address
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Address Line | 7049 RIVERSIDE DR
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City | CHINO
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State | CA
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Zip | 91710-9011
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Country | US
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Telephone | 951-283-2246
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | RDA90918
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License Number State | CA
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