MEDICARE: THOR-ALCYONE L REYES MD

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	2084P0800X	Psychiatry Physician	C38408	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811092596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOR-ALCYONE L REYES MD

Provider Business Mailing Address
First Line	:	5353 TOPANGA CANYON BLVD
Second Line	:	SUITE 100
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1737
Country	:	US
Telephone Number	:	818-704-1579
Fax Number	:	818-704-8790

Provider Business Practice Location Address
First Line	:	5353 TOPANGA CANYON BLVD
Second Line	:	SUITE 100
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1737
Country	:	US
Telephone Number	:	818-704-1579
Fax Number	:	818-704-8790

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	06/18/2008

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