Provider Demographics
NPI:1750034344
Name:REYES, HECTOR FERNANDO
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:FERNANDO
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 RAINBOW AVE
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-3820
Mailing Address - Country:US
Mailing Address - Phone:442-231-9243
Mailing Address - Fax:
Practice Address - Street 1:9201 OAKDALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-6546
Practice Address - Country:US
Practice Address - Phone:833-227-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician