Provider Demographics
NPI:1760593610
Name:REYES, ELIZABETH LEONI (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEONI
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S BEACH BLVD
Mailing Address - Street 2:111
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1853
Mailing Address - Country:US
Mailing Address - Phone:714-826-8800
Mailing Address - Fax:714-226-9760
Practice Address - Street 1:408 S BEACH BLVD
Practice Address - Street 2:111
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1853
Practice Address - Country:US
Practice Address - Phone:714-826-8800
Practice Address - Fax:714-226-9760
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50588208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A505880OtherMEDICAL PROVIDER NO.