Healthcare Provider Details

I. General information

NPI: 1649915794
Provider Name (Legal Business Name): OLIVIA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MARINA BLVD STE D
PITTSBURG CA
94565-2009
US

IV. Provider business mailing address

2068 BRIGHTON DR
PITTSBURG CA
94565-4034
US

V. Phone/Fax

Practice location:
  • Phone: 510-273-4700
  • Fax: 510-530-8033
Mailing address:
  • Phone: 925-207-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: