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NPI Code Detail

MEDICARE: MRS. CORAZON J REYES R.D.,L.D.

MEDICARE: MRS. CORAZON J REYES R.D.,L.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian2001025465MO

General Provider Information

NPI Number : 1053431825
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CORAZON J REYES R.D.,L.D.
Provider Business Mailing Address
First Line : 3973 LOCKPORT DR
Second Line :
City : BRIDGETON
State : MO
Zip : 63044-2116
Country : US
Telephone Number : 314-739-6332
Fax Number :
Provider Business Practice Location Address
First Line : 6065 HELEN AVE
Second Line :
City : BERKELEY
State : MO
Zip : 63134-2013
Country : US
Telephone Number : 314-522-6410
Fax Number : 314-522-0821
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 07/08/2007

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