Healthcare Provider Details

I. General information

NPI: 1205977246
Provider Name (Legal Business Name): JOY REYES NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 E 4TH ST STE 122
SANTA ANA CA
92705-3912
US

IV. Provider business mailing address

6418 E RAVEN CT
ORANGE CA
92869-4398
US

V. Phone/Fax

Practice location:
  • Phone: 714-468-6755
  • Fax:
Mailing address:
  • Phone: 714-532-3492
  • Fax: 562-867-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP9013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: