Provider Demographics
NPI:1003331505
Name:REYES, MARIA ELIZABETH (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARIA ELIZABETH
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:MARIA ELIZABETH
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1100 N CUYAMACA ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1800
Mailing Address - Country:US
Mailing Address - Phone:619-335-7633
Mailing Address - Fax:
Practice Address - Street 1:1100 N CUYAMACA ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1800
Practice Address - Country:US
Practice Address - Phone:619-335-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA776791163W00000X
CA776701163W00000X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)