Basic Information
Provider Information
NPI: 1003000175
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REYES-VASQUEZ
FirstName: BELINDA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4727 SILVER TIP DR
Address2:  
City: WHITTIER
State: CA
PostalCode: 906011763
CountryCode: US
TelephoneNumber: 6263785315
FaxNumber:  
Practice Location
Address1: 322 N AZUSA AVE STE 202
Address2:  
City: LA PUENTE
State: CA
PostalCode: 917444648
CountryCode: US
TelephoneNumber: 6265810800
FaxNumber: 6265810591
Other Information
ProviderEnumerationDate: 08/31/2007
LastUpdateDate: 01/27/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X56153CAY Dental ProvidersDentist 

No ID Information.


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