Provider Demographics
NPI:1487207429
Name:REYES, EDGARDO MENDOZA JR (RN)
Entity Type:Individual
Prefix:MR
First Name:EDGARDO
Middle Name:MENDOZA
Last Name:REYES
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:10802 COLLEGE PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1579
Mailing Address - Country:US
Mailing Address - Phone:562-924-9581
Mailing Address - Fax:562-924-1804
Practice Address - Street 1:10802 COLLEGE PL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1579
Practice Address - Country:US
Practice Address - Phone:562-924-9581
Practice Address - Fax:562-924-1804
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA495237163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent