Healthcare Provider Details

I. General information

NPI: 1184562837
Provider Name (Legal Business Name): AZUCENA JASMIN REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

1189 S NORTON AVE
LOS ANGELES CA
90019-3306
US

V. Phone/Fax

Practice location:
  • Phone: 626-759-9154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: