Provider Demographics
NPI:1609495621
Name:REYES LIN, JENNIFER (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REYES LIN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N. PEPPER AVE
Mailing Address - Street 2:MOB STE 107
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:909-580-1862
Mailing Address - Fax:
Practice Address - Street 1:400 N. PEPPER AVE
Practice Address - Street 2:MOB STE 107
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-580-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program