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General NPI Number Information
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NPI Number | 1891393732
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Entity Type | Individual
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Provider Name | CARLO REYES FNP
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Gender | Male
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 71843 HIGHWAY 111 STE B
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4418
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Country | US
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Telephone | 760-610-5190
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Fax |
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Provider Business Mailing Address
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Address Line | 5236 GODINEZ DR
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City | FONTANA
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State | CA
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Zip | 92336-4624
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Country | US
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Telephone | 626-806-9025
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95015437
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 95015437
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95015437
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License Number State | CA
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