Provider Demographics
NPI:1609202159
Name:REYES, JULIE DANELLE (RDH)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:DANELLE
Last Name:REYES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:DANELLE
Other - Last Name:BALESTERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:3306 DEL MONTE BLVD APT 30
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-2432
Mailing Address - Country:US
Mailing Address - Phone:831-277-1181
Mailing Address - Fax:
Practice Address - Street 1:3306 DEL MONTE BLVD APT 30
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-2432
Practice Address - Country:US
Practice Address - Phone:831-277-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27393124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist