Provider Demographics
NPI:1275078719
Name:REYES, CHRISTOPHER JORDAN
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JORDAN
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 1:64 EAGLEHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-3702
Mailing Address - Country:US
Mailing Address - Phone:408-531-7228
Mailing Address - Fax:
Practice Address - Street 1:64 EAGLEHAVEN CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-3702
Practice Address - Country:US
Practice Address - Phone:408-531-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF1224033171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator