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General NPI Number Information
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NPI Number | 1164556445
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Entity Type | Individual
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Provider Name | MA CRISTINA V DE LOS REYES PT
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 323-857-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 5980 W 71ST ST SUITE 201
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-2711
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Country | US
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Telephone | 317-388-0800
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Fax | 317-388-0805
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 05009159A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 36451
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License Number State | CA
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