Healthcare Provider Details

I. General information

NPI: 1669551891
Provider Name (Legal Business Name): MA MILDRED REY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16415 COLORADO AVE STE 308
PARAMOUNT CA
90723-5053
US

IV. Provider business mailing address

16415 COLORADO AVE STE 308
PARAMOUNT CA
90723-5053
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 NumberA39331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: