Individual
SHANE REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
48090 CALLE DEL SOL, INDIO, CA 92201-6615
(760) 574-0846
Mailing address
48090 CALLE DEL SOL, INDIO, CA 92201-6615
(760) 574-0846
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/05/2011
Last updated
01/05/2011
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