MEDICARE: REY C ARES RN

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	163W00000X	Registered Nurse	RN38651	NV

General Provider Information

NPI Number	:	1194998773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REY C ARES RN

Provider Business Mailing Address
First Line	:	4912 TINDARI ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2119
Country	:	US
Telephone Number	:	702-653-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	4912 TINDARI ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2119
Country	:	US
Telephone Number	:	702-653-3560
Fax Number	:

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

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	04/14/2008

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