Healthcare Provider Details

I. General information

NPI: 1629993001
Provider Name (Legal Business Name): KASSANDRA IRENE REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

432 N HARRISON AVE APT 4
OXNARD CA
93030-3638
US

IV. Provider business mailing address

432 N HARRISON AVE APT 4
OXNARD CA
93030-3638
US

V. Phone/Fax

Practice location:
  • Phone: 805-873-6084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: