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General NPI Number Information
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NPI Number | 1124842067
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Entity Type | Individual
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Provider Name | NANCY INGE REYES
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 536 W VISTA WAY STE A
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City | VISTA
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State | CA
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Zip | 92083-5704
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Country | US
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Telephone | 760-758-1650
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Fax | 760-758-1701
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Provider Business Mailing Address
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Address Line | 9808 VENICE BLVD STE 300
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City | CULVER CITY
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State | CA
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Zip | 90232-2750
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Country | US
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Telephone | 310-237-0454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number | MPSS-GBZWPV
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-GBZWPV
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License Number State | CA
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