Provider Demographics
NPI:1801035316
Name:REYES, CRISTINA (RN)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6075 PURISIMA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-5959
Mailing Address - Country:US
Mailing Address - Phone:909-565-3046
Mailing Address - Fax:
Practice Address - Street 1:6075 PURISIMA PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-5959
Practice Address - Country:US
Practice Address - Phone:909-565-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-08
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse