Provider Demographics
NPI:1033484191
Name:REYES, WILIBALDO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILIBALDO
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2404
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001-2404
Mailing Address - Country:US
Mailing Address - Phone:408-729-9700
Mailing Address - Fax:
Practice Address - Street 1:1430 FREEDOM BLVD STE D
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2752
Practice Address - Country:US
Practice Address - Phone:831-763-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant