Provider Demographics
NPI:1073382206
Name:REYES, FLORDELIS M (LICENSEE)
Entity Type:Individual
Prefix:
First Name:FLORDELIS
Middle Name:M
Last Name:REYES
Suffix:
Gender:F
Credentials:LICENSEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 NAVARONNE WAY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2173
Mailing Address - Country:US
Mailing Address - Phone:925-324-2611
Mailing Address - Fax:925-849-5432
Practice Address - Street 1:810 NAVARONNE WAY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-2173
Practice Address - Country:US
Practice Address - Phone:925-324-2611
Practice Address - Fax:925-849-5432
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA071440636310400000X
CA075601014310400000X
CA075600201310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility