Provider Demographics
NPI:1215599915
Name:REYES, CHARLENE MAE
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MAE
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 1:810 KALI PL
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-6102
Mailing Address - Country:US
Mailing Address - Phone:916-316-7200
Mailing Address - Fax:916-529-4161
Practice Address - Street 1:5665 POWER INN RD STE 121
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-2383
Practice Address - Country:US
Practice Address - Phone:916-669-9038
Practice Address - Fax:916-529-4161
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49907208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation