Provider Demographics
NPI:1518748318
Name:REYES, TANYA (DC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 BRISTOL ST STE C105
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5944
Mailing Address - Country:US
Mailing Address - Phone:714-557-9454
Mailing Address - Fax:714-557-9534
Practice Address - Street 1:2900 BRISTOL ST STE C105
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5944
Practice Address - Country:US
Practice Address - Phone:714-557-9454
Practice Address - Fax:714-557-9534
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor