Provider Demographics
NPI:1639295082
Name:REYES, ANTONIO JR
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:REYES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TONE
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2931 FANSHELL WALK
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-2479
Mailing Address - Country:US
Mailing Address - Phone:805-469-5420
Mailing Address - Fax:
Practice Address - Street 1:1722 S LEWIS RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8520
Practice Address - Country:US
Practice Address - Phone:805-445-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor