Provider Demographics
NPI:1437340445
Name:REYES, MARIA LOURDES FERNANDEZ (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MARIA LOURDES
Middle Name:FERNANDEZ
Last Name:REYES
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Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:PO BOX 1592
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-1592
Mailing Address - Country:US
Mailing Address - Phone:619-988-2210
Mailing Address - Fax:619-280-4916
Practice Address - Street 1:6371 RANCHO MISSION RD
Practice Address - Street 2:UNIT 2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2016
Practice Address - Country:US
Practice Address - Phone:619-988-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49139207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49139OtherCALIFORNIA LICENSE