Provider Demographics
NPI:1689887622
Name:REYES, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:657 E ARROW HWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6013
Mailing Address - Country:US
Mailing Address - Phone:626-963-1530
Mailing Address - Fax:626-339-3031
Practice Address - Street 1:657 E ARROW HWY
Practice Address - Street 2:SUITE G
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6013
Practice Address - Country:US
Practice Address - Phone:626-963-1530
Practice Address - Fax:626-339-3031
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA62046208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A620460Medicaid