Healthcare Provider Details

I. General information

NPI: 1932920543
Provider Name (Legal Business Name): HUBERT REYES MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 SOUTH ARROYO PKWY SUITE 100
PASADENA CA
91105
US

IV. Provider business mailing address

675 SOUTH ARROYO PKWY SUITE 100
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 626-844-3884
  • Fax: 626-844-3886
Mailing address:
  • Phone: 626-844-3884
  • Fax: 626-844-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: HUBERT REYES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-844-3884