Individual
DR. KENNETH MARCEL DE LOS REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11234 ANDERSON ST, LOMA LINDA, CA 92350-1716
(909) 558-4419
(909) 558-4825
Mailing address
11234 ANDERSON ST, LOMA LINDA, CA 92350-1716
(909) 558-4419
(909) 558-4825
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
C131686
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134388879
—
CA
Enumeration date
06/06/2008
Last updated
02/28/2022
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