MEDICARE: EVA 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	163WC1500X	Community Health Registered Nurse	83814	CA

General Provider Information

NPI Number	:	1336561000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA REYES

Provider Business Mailing Address
First Line	:	12344 CORNWALLIS SQ
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5560 OVERLAND AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1204
Country	:	US
Telephone Number	:	858-459-5934
Fax Number	:

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

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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Directions to “ EVA REYES ” Practice Location

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