MEDICARE: REYES PSYCHOLOGY, APC

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	103TC0700X	Clinical Psychologist	PSY19734	CA

General Provider Information

NPI Number	:	1710134143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYES PSYCHOLOGY, APC

Provider Business Mailing Address
First Line	:	3149 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5613
Country	:	US
Telephone Number	:	858-361-1989
Fax Number	:	858-373-2148

Provider Business Practice Location Address
First Line	:	3149 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5613
Country	:	US
Telephone Number	:	858-361-1989
Fax Number	:	858-373-2148

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAFAEL M REYES
Credential	:	PSY.D.
Telephone Number	:	858-361-1989

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	05/03/2013

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