Healthcare Provider Details

I. General information

NPI: 1871416024
Provider Name (Legal Business Name): TIMOTHY RYAN REYES BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE STE 500
LONG BEACH CA
90806-2330
US

IV. Provider business mailing address

19938 MAPES AVE
CERRITOS CA
90703-6549
US

V. Phone/Fax

Practice location:
  • Phone: 562-304-1740
  • Fax:
Mailing address:
  • Phone: 562-965-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95406717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: