Provider Demographics
NPI:1669503579
Name:REYES, MARITZA MERCEDES
Entity Type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:MERCEDES
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARITZA
Other - Middle Name:MERCEDES
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1411 N. GRAND AVE.
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724
Mailing Address - Country:US
Mailing Address - Phone:626-831-6848
Mailing Address - Fax:
Practice Address - Street 1:1411 N. GRAND AVE.
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724
Practice Address - Country:US
Practice Address - Phone:626-831-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner