Healthcare Provider Details

I. General information

NPI: 1780588384
Provider Name (Legal Business Name): ALEXANDER REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 MARKET ST
VENTURA CA
93003-7783
US

IV. Provider business mailing address

12428 PRESILLA RD
SANTA ROSA VALLEY CA
93012-9329
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-1401
  • Fax:
Mailing address:
  • Phone: 818-312-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: