Healthcare Provider Details

I. General information

NPI: 1790434512
Provider Name (Legal Business Name): NORELLA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N BRIDGE ST
VISALIA CA
93291-5014
US

IV. Provider business mailing address

1613 S TIPTON CT
VISALIA CA
93292-5577
US

V. Phone/Fax

Practice location:
  • Phone: 859-377-1176
  • Fax:
Mailing address:
  • Phone: 859-377-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: