MEDICARE: MRS. REBECCA ROBANCHO REYES M.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
1	207Q00000X	Family Medicine Physician	037649	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000131576	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316939184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA ROBANCHO REYES M.D.

Provider Business Mailing Address
First Line	:	14701 DETROIT AVE
Second Line	:	SUITE 740
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4115
Country	:	US
Telephone Number	:	216-226-0110
Fax Number	:	216-226-3110

Provider Business Practice Location Address
First Line	:	14701 DETROIT AVE
Second Line	:	SUITE 740
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4115
Country	:	US
Telephone Number	:	216-226-0110
Fax Number	:	216-226-3110

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	03/29/2011

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