Healthcare Provider Details

I. General information

NPI: 1700364833
Provider Name (Legal Business Name): AUDREY TUANO REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 ZION AVE
SAN DIEGO CA
92120-2507
US

IV. Provider business mailing address

4647 ZION AVE
SAN DIEGO CA
92120-2507
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-5864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number31870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: