Provider Demographics
NPI:1609234020
Name:REYES, CYNTHIA B (MT)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:B
Last Name:REYES
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 AVENIDA DE LAS ADELSAS
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4712
Mailing Address - Country:US
Mailing Address - Phone:858-349-3128
Mailing Address - Fax:
Practice Address - Street 1:2221 LAS PALMAS DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1528
Practice Address - Country:US
Practice Address - Phone:858-349-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2685225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist