Provider Demographics
NPI:1700226941
Name:REYES-BERGANO, RACHEL A (DO)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:A
Last Name:REYES-BERGANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:A
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1400 S GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3048
Mailing Address - Country:US
Mailing Address - Phone:213-741-1106
Mailing Address - Fax:213-741-1423
Practice Address - Street 1:1400 S GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3048
Practice Address - Country:US
Practice Address - Phone:213-741-1106
Practice Address - Fax:213-741-1423
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program