Healthcare Provider Details

I. General information

NPI: 1750896544
Provider Name (Legal Business Name): JOHNNY ABEL REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14234 BELLFLOWER BLVD
BELLFLOWER CA
90706-2449
US

IV. Provider business mailing address

3826 VIRGINIA ST
LYNWOOD CA
90262-4451
US

V. Phone/Fax

Practice location:
  • Phone: 424-213-3372
  • Fax:
Mailing address:
  • Phone: 424-213-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: