Healthcare Provider Details

I. General information

NPI: 1366675878
Provider Name (Legal Business Name): MIRIAM REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 WOODMAN AVE
ARLETA CA
91331-6401
US

IV. Provider business mailing address

8902 WOODMAN AVE
ARLETA CA
91331-6401
US

V. Phone/Fax

Practice location:
  • Phone: 818-830-7033
  • Fax: 818-830-7280
Mailing address:
  • Phone: 818-830-7033
  • Fax: 818-830-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: