Provider Demographics
NPI:1518721489
Name:REYES, MONICA TONANTZIN
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:TONANTZIN
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38924 AUTUMN WOODS RD
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6251
Mailing Address - Country:US
Mailing Address - Phone:951-501-9820
Mailing Address - Fax:
Practice Address - Street 1:27713 JEFFERSON AVE STE 103
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2629
Practice Address - Country:US
Practice Address - Phone:951-501-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78410225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist