MEDICARE: MISS LYDIA A. REYES NP

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	363LF0000X	Family Nurse Practitioner	20384	CA

General Provider Information

NPI Number	:	1447552229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LYDIA A. REYES NP

Provider Business Mailing Address
First Line	:	840 TOWNE CENTER DRIVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-5900
Country	:	US
Telephone Number	:	909-398-1550
Fax Number	:	909-398-1488

Provider Business Practice Location Address
First Line	:	8330 RED OAK STREET STE 101
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-0603
Country	:	US
Telephone Number	:	909-987-4922
Fax Number	:	909-466-1190

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

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	10/19/2018

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