Provider Demographics
NPI:1790303220
Name:REYES, MARLEN GUADALUPE
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:GUADALUPE
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 W IRIS ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3521
Mailing Address - Country:US
Mailing Address - Phone:805-302-1021
Mailing Address - Fax:
Practice Address - Street 1:181 W IRIS ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3521
Practice Address - Country:US
Practice Address - Phone:805-302-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health