Healthcare Provider Details

I. General information

NPI: 1073000980
Provider Name (Legal Business Name): GRISELDA ARLENE REYES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CITY BLVD W STE 1400
ORANGE CA
92868-5900
US

IV. Provider business mailing address

333 CITY BLVD W STE 1400
ORANGE CA
92868-5900
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8224
  • Fax:
Mailing address:
  • Phone: 714-456-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA166988
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA166988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: