Healthcare Provider Details

I. General information

NPI: 1962978494
Provider Name (Legal Business Name): CLAUDIA LORENA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8612 FIRESTONE BLVD
DOWNEY CA
90241-5243
US

IV. Provider business mailing address

10239 TRABUCO ST
BELLFLOWER CA
90706-5051
US

V. Phone/Fax

Practice location:
  • Phone: 562-382-1528
  • Fax:
Mailing address:
  • Phone: 562-572-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA57613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: