MEDICARE: MR. CHRISTIAN REYES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP95014567	CA

General Provider Information

NPI Number	:	1538782214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTIAN REYES

Provider Business Mailing Address
First Line	:	8453 PENNY DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-1488
Country	:	US
Telephone Number	:	714-785-3639
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 WILSHIRE BLVD STE 2780
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1901
Country	:	US
Telephone Number	:	714-785-3639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	11/08/2022

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Directions to “ MR. CHRISTIAN REYES ” Practice Location

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