Healthcare Provider Details

I. General information

NPI: 1295003085
Provider Name (Legal Business Name): MA. MILDRED R. REY, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16415 COLORADO AVE STE 308
PARAMOUNT CA
90723-5035
US

IV. Provider business mailing address

16415 COLORADO AVE STE 308
PARAMOUNT CA
90723-5035
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-5581
  • Fax: 562-630-0411
Mailing address:
  • Phone: 562-630-5581
  • Fax: 562-630-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA393310
License Number StateCA

VIII. Authorized Official

Name: DR. MA. MILDRED REY
Title or Position: DOCTOR
Credential: M.D.
Phone: 562-630-5581