Healthcare Provider Details

I. General information

NPI: 1962018721
Provider Name (Legal Business Name): KATHRYN REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD STE. AC1326
LOS ANGELES CA
90048
US

IV. Provider business mailing address

8700 BEVERLY BLVD STE. AC1326
LOS ANGELES CA
90048
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-3696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: