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Individual
MARK REYES DE JESUS
Active
Individual
MARK REYES DE JESUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
215600411
STATE ID
NY
Enumeration date
10/24/2016
Last updated
10/24/2016
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