REYNALDO L REYES JR. PHYSICIAN ASSISTANT
NPI 1306800644
Military Health Care Provider - Independent Duty Corpsman in San Diego, CA

Q: What is the provider's specialty?

The provider's specialty is Military Health Care Provider with taxonomy code 1710I1002X and a focus in Independent Duty Corpsman.

Active since April 13, 2006PECOS Enrolled

35000 GUADALCANAL ST, BRANCH MEDICAL CLINIC MARINE CORPS RECRUIT DEPOT, SAN DIEGO, CA 92140(619) 532-4056 Get Directions Write a Review

NPPES record last updated: September 22, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Reynaldo L Reyes Jr. Physician Assistant NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REYNALDO L REYES JR. PHYSICIAN ASSISTANT (NPI 1306800644) is an individual independent duty corpsman provider in San Diego, California and active in the NPI registry since April 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1306800644

Entity TypeIndividualMale

Primary Taxonomy1710I1002X

Provider Legal NameREYNALDO L REYES JR.Credential: PHYSICIAN ASSISTANT

Location Address35000 GUADALCANAL ST, BRANCH MEDICAL CLINIC MARINE CORPS RECRUIT DEPOTSan Diego, CA 92140

Mailing Address12497 Conquistador WaySan Diego, CA 92128-2152 · (858) 603-3106

Phone(619) 532-4056

Sole ProprietorYes

Enumeration DateApril 13, 2006

Last NPPES UpdateSeptember 22, 2022

NPPES CertifiedSeptember 22, 2022

✔ NPI 1306800644 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers

Taxonomy Code1710I1002X

Definition

A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.

Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X · License 58601 (CA)

35000 GUADALCANAL ST, San Diego, CA 92140

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Reynaldo L Reyes Jr. Physician Assistant is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.