Provider Demographics
NPI:1790277598
Name:DE LOS REYES, ESTEBAN JUAN (BA)
Entity Type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:JUAN
Last Name:DE LOS REYES
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14327 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9041
Mailing Address - Country:US
Mailing Address - Phone:951-443-2295
Mailing Address - Fax:951-443-2255
Practice Address - Street 1:14327 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9041
Practice Address - Country:US
Practice Address - Phone:951-443-2295
Practice Address - Fax:951-443-2255
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator