Provider Demographics
NPI:1619984846
Name:REYES, LINDA C (NP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:C
Last Name:REYES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MR
Other - First Name:MA. LOURDES
Other - Middle Name:C
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1160 CHERI DR
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-2602
Mailing Address - Country:US
Mailing Address - Phone:951-201-7075
Mailing Address - Fax:562-365-3501
Practice Address - Street 1:1160 CHERI DR
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-2602
Practice Address - Country:US
Practice Address - Phone:951-201-7075
Practice Address - Fax:562-365-3501
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15536363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15536OtherNP LICENSE
CA428058OtherRN LICENSE