Provider Demographics
NPI:1194391680
Name:REYES, BIANCA ROSE
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:ROSE
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 DEERLANE DR
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1653
Mailing Address - Country:US
Mailing Address - Phone:323-474-1782
Mailing Address - Fax:
Practice Address - Street 1:3222 DEERLANE DR
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1653
Practice Address - Country:US
Practice Address - Phone:323-474-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician