Healthcare Provider Details

I. General information

NPI: 1871400309
Provider Name (Legal Business Name): ROSA ISELA REYES MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 ONE HALF WEST ALAMEDA AVENUE
BURBANK CA
91505
US

IV. Provider business mailing address

3419 ONE HALF WEST ALAMEDA AVENUE
BURBANK CA
91505
US

V. Phone/Fax

Practice location:
  • Phone: 818-284-0049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: