Provider Demographics
NPI:1790317519
Name:REYES, SHERLON SIMBULAN
Entity Type:Individual
Prefix:
First Name:SHERLON
Middle Name:SIMBULAN
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 1:3139 SWEETWATER SPRINGS BLVD APT 145
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1535
Mailing Address - Country:US
Mailing Address - Phone:619-352-8902
Mailing Address - Fax:
Practice Address - Street 1:1325 PACIFIC HWY UNIT 3501
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2600
Practice Address - Country:US
Practice Address - Phone:858-945-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY7767469OtherDRIVER LICESNE