Provider Demographics
NPI:1932466760
Name:ELIZABETH R. REYES, M.D., APC
Entity Type:Organization
Organization Name:ELIZABETH R. REYES, M.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-446-9030
Mailing Address - Street 1:301 W BASTANCHURY RD STE 115
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3423
Mailing Address - Country:US
Mailing Address - Phone:714-446-9030
Mailing Address - Fax:714-446-9130
Practice Address - Street 1:301 W BASTANCHURY RD STE 115
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3423
Practice Address - Country:US
Practice Address - Phone:714-446-9030
Practice Address - Fax:714-446-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67305208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8688134Medicaid