Healthcare Provider Details

I. General information

NPI: 1326951849
Provider Name (Legal Business Name): ELIZABETH REYES
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 710145
SAN DIEGO CA
92171-0145
US

IV. Provider business mailing address

PO BOX 2003
LA MESA CA
91943-2003
US

V. Phone/Fax

Practice location:
  • Phone: 619-408-0064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: