Provider Demographics
NPI:1184681975
Name:REYES, VALVINCENT ABANILLA (BCD, LCSW)
Entity Type:Individual
Prefix:
First Name:VALVINCENT
Middle Name:ABANILLA
Last Name:REYES
Suffix:
Gender:M
Credentials:BCD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23031 PETROLEUM AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2831
Mailing Address - Country:US
Mailing Address - Phone:310-418-7227
Mailing Address - Fax:310-539-3545
Practice Address - Street 1:USA MEDDAC
Practice Address - Street 2:DR. MARY E. WALKER CENTER BUILDING 170
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-3631
Practice Address - Fax:760-380-6469
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS111381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical