Healthcare Provider Details

I. General information

NPI: 1689584807
Provider Name (Legal Business Name): KATIE REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MUIR RD
MARTINEZ CA
94553-4672
US

IV. Provider business mailing address

18303 KITTRIDGE ST APT 38
RESEDA CA
91335-6162
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-1000
  • Fax:
Mailing address:
  • Phone: 818-926-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: