MEDICARE: MA MILDRED REY M.D.

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	208000000X	Pediatrics Physician	A39331	CA

General Provider Information

NPI Number	:	1669551891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MA MILDRED REY M.D.

Provider Business Mailing Address
First Line	:	16415 COLORADO AVE STE 308
Second Line	:
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-5053
Country	:	US
Telephone Number	:	562-630-5581
Fax Number	:	562-630-0411

Provider Business Practice Location Address
First Line	:	16415 COLORADO AVE STE 308
Second Line	:
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-5053
Country	:	US
Telephone Number	:	562-630-5581
Fax Number	:	562-630-0411

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	01/30/2025

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