Healthcare Provider Details

I. General information

NPI: 1891403853
Provider Name (Legal Business Name): IREEN BANAAG REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27811 GREENSPOT RD
HIGHLAND CA
92346-4361
US

IV. Provider business mailing address

1595 SILVER CUP CT
REDLANDS CA
92374-2771
US

V. Phone/Fax

Practice location:
  • Phone: 909-443-2584
  • Fax: 833-916-2036
Mailing address:
  • Phone: 909-583-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: