Healthcare Provider Details

I. General information

NPI: 1457047375
Provider Name (Legal Business Name): NATALIE LIZET REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE LIZET GUTIERREZ

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E DAKOTA AVE
FRESNO CA
93726-4821
US

IV. Provider business mailing address

1925 E DAKOTA AVE
FRESNO CA
93726-4821
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9180
  • Fax:
Mailing address:
  • Phone: 559-894-4569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: