Provider Demographics
NPI:1508438755
Name:REYES, CRISTINA DESIREE (LM)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:DESIREE
Last Name:REYES
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4710
Mailing Address - Country:US
Mailing Address - Phone:760-681-0917
Mailing Address - Fax:
Practice Address - Street 1:4545 FANUEL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2904
Practice Address - Country:US
Practice Address - Phone:858-900-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife