MEDICARE: MS. MARIBEL DELOS REYES ILEJAY FNP

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
1	363LF0000X	Family Nurse Practitioner	22600	CA

General Provider Information

NPI Number	:	1164862850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIBEL DELOS REYES ILEJAY FNP

Provider Business Mailing Address
First Line	:	2315 STOCKTON BLVD # 2021
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2201
Country	:	US
Telephone Number	:	916-907-6478
Fax Number	:	916-734-6564

Provider Business Practice Location Address
First Line	:	2315 STOCKTON BLVD # 2021
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2201
Country	:	US
Telephone Number	:	916-907-6478
Fax Number	:	916-734-6564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	03/06/2015

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