Healthcare Provider Details

I. General information

NPI: 1538704275
Provider Name (Legal Business Name): TIFFANY MONIQUE REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 E GILBERT ST
SAN BERNARDINO CA
92415-1003
US

IV. Provider business mailing address

1988 BELLE ST
SAN BERNARDINO CA
92404-4717
US

V. Phone/Fax

Practice location:
  • Phone: 626-488-9891
  • Fax:
Mailing address:
  • Phone: 626-488-9891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: