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General NPI Number Information
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NPI Number | 1144224908
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Entity Type | Individual
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Provider Name | EVANGELINE A REYES M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 260 E. ONTARIO AVENUE STE. # 101
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City | CORONA
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State | CA
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Zip | 92879
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Country | US
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Telephone | 951-371-2411
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Fax | 951-284-0177
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Provider Business Mailing Address
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Address Line | 18111 BROOKHURST STREET STE. # 6100
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7516
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Country | US
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Telephone | 714-698-0300
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Fax | 714-698-0303
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A64361
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License Number State | CA
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