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General NPI Number Information
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NPI Number | 1740397413
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Entity Type | Individual
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Provider Name | ERICSON P REYES
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 3300 E SOUTH ST STE 308
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City | LAKEWOOD
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State | CA
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Zip | 90805-4598
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Country | US
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Telephone | 562-630-3111
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Fax | 562-630-3107
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Provider Business Mailing Address
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Address Line | PO BOX 879
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City | LAKEWOOD
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State | CA
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Zip | 90714-0879
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Country | US
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Telephone | 562-630-3111
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Fax | 562-630-3107
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP15834
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License Number State | CA
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