Healthcare Provider Details

I. General information

NPI: 1114119591
Provider Name (Legal Business Name): DARA REYES PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date: 12/17/2009
Reactivation Date: 02/11/2010

III. Provider practice location address

1560 E CHEVY CHASE DR STE 130
GLENDALE CA
91206-4140
US

IV. Provider business mailing address

1560 E CHEVY CHASE DR STE 130
GLENDALE CA
91206-4140
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-0340
  • Fax: 858-467-7161
Mailing address:
  • Phone: 818-240-0340
  • Fax: 858-467-7161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 27297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: