Provider Demographics
NPI:1528190188
Name:DE LOS REYES, MARY MITZI (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MITZI
Last Name:DE LOS REYES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 SANTA FLORA RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1740
Mailing Address - Country:US
Mailing Address - Phone:619-421-7486
Mailing Address - Fax:
Practice Address - Street 1:6950 LEVANT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6010
Practice Address - Country:US
Practice Address - Phone:858-694-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535204163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health