MEDICARE: MISS CYNTHIA B REYES M.T.

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	225700000X	Massage Therapist	2685	CA

General Provider Information

NPI Number	:	1609234020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CYNTHIA B REYES M.T.

Provider Business Mailing Address
First Line	:	1443 AVENIDA DE LAS ADELSAS
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-4712
Country	:	US
Telephone Number	:	858-349-3128
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 LAS PALMAS DR
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92011-1528
Country	:	US
Telephone Number	:	858-349-3128
Fax Number	:

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

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	01/29/2016

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