Healthcare Provider Details

I. General information

NPI: 1114846573
Provider Name (Legal Business Name): EM PSYCHE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 TOWNSGATE RD STE 200
WESTLAKE VILLAGE CA
91361-5995
US

IV. Provider business mailing address

2475 TOWNSGATE RD STE 200
WESTLAKE VILLAGE CA
91361-5995
US

V. Phone/Fax

Practice location:
  • Phone: 805-253-2773
  • Fax: 877-693-1682
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLO REYES
Title or Position: PRESIDENT
Credential: MD
Phone: 805-253-2773