Healthcare Provider Details

I. General information

NPI: 1831484328
Provider Name (Legal Business Name): RUTH NAOMI REYES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16541 POTTER CIR
HUNTINGTON BEACH CA
92647-4822
US

IV. Provider business mailing address

16541 POTTER CIR
HUNTINGTON BEACH CA
92647-4822
US

V. Phone/Fax

Practice location:
  • Phone: 714-596-1920
  • Fax:
Mailing address:
  • Phone: 714-596-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: