Healthcare Provider Details

I. General information

NPI: 1952264780
Provider Name (Legal Business Name): MAUREEN POBLADOR REYES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E WALNUT AVE
MONROVIA CA
91016-3431
US

IV. Provider business mailing address

818 N FOXDALE AVE
WEST COVINA CA
91790-1214
US

V. Phone/Fax

Practice location:
  • Phone: 818-450-1188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: