Healthcare Provider Details

I. General information

NPI: 1164997086
Provider Name (Legal Business Name): IVONNE E REYES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2018
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N BRENT ST STE 502
VENTURA CA
93003-2840
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-2000
  • Fax: 805-653-1644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: