Provider Demographics
NPI:1659591147
Name:REYES, PHYLLIS JEAN
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:JEAN
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7303 E CALLE DURANGO
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1024
Mailing Address - Country:US
Mailing Address - Phone:714-974-3454
Mailing Address - Fax:
Practice Address - Street 1:7303 E CALLE DURANGO
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1024
Practice Address - Country:US
Practice Address - Phone:714-974-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator