Provider Demographics
NPI:1780078733
Name:REYES-RUFO, IVAN JAVIER (DO)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:JAVIER
Last Name:REYES-RUFO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 STEPTOE ST
Mailing Address - Street 2:121
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8539
Mailing Address - Country:US
Mailing Address - Phone:773-425-0321
Mailing Address - Fax:
Practice Address - Street 1:900 S AUBURN ST
Practice Address - Street 2:STE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5621
Practice Address - Country:US
Practice Address - Phone:773-425-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL60557601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine