MEDICARE: ANTONIO 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101YM0800X	OTHER	CA	COUNSELOR

General Provider Information

NPI Number	:	1356433361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO REYES

Provider Business Mailing Address
First Line	:	1633 E 4TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-5163
Country	:	US
Telephone Number	:	714-565-2830
Fax Number	:	714-565-2833

Provider Business Practice Location Address
First Line	:	1633 E 4TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-5163
Country	:	US
Telephone Number	:	714-565-2830
Fax Number	:	714-565-2833

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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Directions to “ ANTONIO REYES ” Practice Location

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