Provider Demographics
NPI:1376767376
Name:REYES, EVA JUDITH (NP)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:JUDITH
Last Name:REYES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7180 MOHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2633
Mailing Address - Country:US
Mailing Address - Phone:760-365-8500
Mailing Address - Fax:760-365-8599
Practice Address - Street 1:7180 MOHAWK TRL
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2633
Practice Address - Country:US
Practice Address - Phone:760-365-8500
Practice Address - Fax:760-365-8599
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA16249364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16249Medicare UPIN