| Doctor Name: | MR. EDMOND CHAN REYES |
| NPI Number: | 1659449221 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | INDEPENDENT CORPSMAN |
| License Number: | |
| Business Practice Address: | Naval Air Station North Island Bldg 290 Sandiego, CA - 92135 |
| Business Phone Number: | 6197671496 |
| Business Fax Number: | 6197671497 |
| Mailing Address: | 35755 Coral Dr, WINCHESTER |
| State: | CA |
| Postal Code: | 92596 |
| Phone Number: | 9518528530 |
| Fax Number: | 6197671497 |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |