Provider Demographics
NPI:1295003085
Name:MA. MILDRED R. REY, M.D.
Entity Type:Organization
Organization Name:MA. MILDRED R. REY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MA. MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:REY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-630-5581
Mailing Address - Street 1:16415 COLORADO AVE
Mailing Address - Street 2:STE 308
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5035
Mailing Address - Country:US
Mailing Address - Phone:562-630-5581
Mailing Address - Fax:562-630-0411
Practice Address - Street 1:16415 COLORADO AVE
Practice Address - Street 2:STE 308
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5035
Practice Address - Country:US
Practice Address - Phone:562-630-5581
Practice Address - Fax:562-630-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA393310208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A393310OtherMEDI-CAL PROVIDER NUMBER