Healthcare Provider Details

I. General information

NPI: 1912830787
Provider Name (Legal Business Name): MARIA JIMENA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

51864 AVENIDA CARRANZA
LA QUINTA CA
92253-3156
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8650
  • Fax:
Mailing address:
  • Phone: 760-848-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: