Provider Demographics
NPI:1073991527
Name:REYES, LUIS
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 1ST ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1547
Mailing Address - Country:US
Mailing Address - Phone:800-785-8953
Mailing Address - Fax:303-922-4640
Practice Address - Street 1:2655 1ST ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1547
Practice Address - Country:US
Practice Address - Phone:800-785-8953
Practice Address - Fax:303-922-4640
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic