Healthcare Provider Details

I. General information

NPI: 1124842067
Provider Name (Legal Business Name): NANCY INGE REYES CPSS, RAOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 CAPALINA RD
SAN MARCOS CA
92069-1288
US

IV. Provider business mailing address

1560 CAPALINA RD
SAN MARCOS CA
92069-1288
US

V. Phone/Fax

Practice location:
  • Phone: 760-744-2104
  • Fax:
Mailing address:
  • Phone: 760-744-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberMPSS-GBZWPV
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSUDRCI26009
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberSURRCI26009
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-GBZWPV
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: