Provider Demographics
NPI:1225783327
Name:REYES, JOSE LORENZO
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LORENZO
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 1:1500 N GRAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2611
Mailing Address - Country:US
Mailing Address - Phone:949-540-9992
Mailing Address - Fax:
Practice Address - Street 1:1500 N GRAND AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2611
Practice Address - Country:US
Practice Address - Phone:949-540-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician