Provider Demographics
NPI:1104836931
Name:REYES, ROBIN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ELIZABETH
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 1:11602 VALLEY FORGE WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-8286
Mailing Address - Country:US
Mailing Address - Phone:661-334-4403
Mailing Address - Fax:
Practice Address - Street 1:2633 16TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3348
Practice Address - Country:US
Practice Address - Phone:661-334-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18457363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical