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General NPI Number Information
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NPI Number | 1659449221
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Entity Type | Individual
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Provider Name | EDMOND CHAN REYES INDEPENDENT CORPSMAN
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | NAVAL AIR STATION NORTH ISLAND BLDG 290
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City | SANDIEGO
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State | CA
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Zip | 92135
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Country | US
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Telephone | 619-767-1496
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Fax | 619-767-1497
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Provider Business Mailing Address
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Address Line | 35755 CORAL DR
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City | WINCHESTER
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State | CA
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Zip | 92596
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Country | US
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Telephone | 951-852-8530
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Fax | 619-767-1497
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State | CA
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