Healthcare Provider Details

I. General information

NPI: 1720903651
Provider Name (Legal Business Name): MILDRED REYES
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

1000 S FREMONT AVE
ALHAMBRA CA
91803-8800
US

V. Phone/Fax

Practice location:
  • Phone: 626-299-3567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number483798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: