Healthcare Provider Details

I. General information

NPI: 1588791958
Provider Name (Legal Business Name): MARGUERITA REYES ENO CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28605 SHENANDOAH DRIVE
LAKE ARROWHEAD CA
92352
US

IV. Provider business mailing address

PO BOX 7
SKYFOREST CA
92385-0007
US

V. Phone/Fax

Practice location:
  • Phone: 310-699-7949
  • Fax:
Mailing address:
  • Phone: 310-699-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP19311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: