Provider Demographics
NPI:1700068400
Name:DE LOS REYES, JOE MARCO ESPINO (CRNA)
Entity type:Individual
Prefix:
First Name:JOE MARCO
Middle Name:ESPINO
Last Name:DE LOS REYES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:MARC
Other - Middle Name:E
Other - Last Name:DE LOS REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:809 UNIVERSITY BLVD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2029
Mailing Address - Country:US
Mailing Address - Phone:205-759-7352
Mailing Address - Fax:205-759-6397
Practice Address - Street 1:809 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2029
Practice Address - Country:US
Practice Address - Phone:205-759-7352
Practice Address - Fax:205-759-6397
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-100986163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL077985OtherAMERICAN ASSOCIATION OF NURSE ANESTHETISTS (CERTIFICATION)