Provider Demographics
NPI:1043677859
Name:REYES, ERIKA CRYSTAL (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:CRYSTAL
Last Name:REYES
Suffix:
Gender:F
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 1:1027 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-2304
Mailing Address - Country:US
Mailing Address - Phone:951-833-5881
Mailing Address - Fax:
Practice Address - Street 1:127 N MCKINLEY ST STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6563
Practice Address - Country:US
Practice Address - Phone:951-278-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53117363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical