Healthcare Provider Details

I. General information

NPI: 1073227187
Provider Name (Legal Business Name): JONATHAN REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E HEIM AVE STE 205
ORANGE CA
92865-3016
US

IV. Provider business mailing address

270 N PALM DR, ORANGE, CA 92868
ORANGE CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 714-464-9080
  • Fax:
Mailing address:
  • Phone: 714-997-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: