MEDICARE: MELANIE REYES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF 72709	CA
2	106H00000X	Marriage & Family Therapist	92642	CA

General Provider Information

NPI Number	:	1316288954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE REYES

Provider Business Mailing Address
First Line	:	PO BOX 883
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92856-6883
Country	:	US
Telephone Number	:	949-424-3717
Fax Number	:

Provider Business Practice Location Address
First Line	:	594 N GLASSELL ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-6748
Country	:	US
Telephone Number	:	949-424-3717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	09/16/2019

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Directions to “ MELANIE REYES ” Practice Location

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