Healthcare Provider Details

I. General information

NPI: 1710813589
Provider Name (Legal Business Name): LIZ BETH REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIZ BETH BONIFACIO REYES

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 S IMPERIAL AVE
EL CENTRO CA
92243-4241
US

IV. Provider business mailing address

636 EMERALD ST
IMPERIAL CA
92251-2512
US

V. Phone/Fax

Practice location:
  • Phone: 760-997-7800
  • Fax:
Mailing address:
  • Phone: 760-791-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number59302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: