Healthcare Provider Details

I. General information

NPI: 1841138377
Provider Name (Legal Business Name): SAMANTHA STAR REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S MYRTLE AVE STE 100
MONROVIA CA
91016-3406
US

IV. Provider business mailing address

140 S ELLIOTT AVE UNIT B
AZUSA CA
91702-4530
US

V. Phone/Fax

Practice location:
  • Phone: 626-775-7888
  • Fax:
Mailing address:
  • Phone: 626-629-9654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: