Provider Demographics
NPI:1679647168
Name:REYES, CATHERINE JOYCE (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JOYCE
Last Name:REYES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8112 MOORCROFT AVENUE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304
Mailing Address - Country:US
Mailing Address - Phone:818-620-6256
Mailing Address - Fax:
Practice Address - Street 1:OLIVE VIEW UCLA MED CTR
Practice Address - Street 2:14445 OLIVE VIEW DRIVE
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-364-3205
Practice Address - Fax:818-364-4573
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP16932363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner