Provider Demographics
NPI:1942490974
Name:REYES, JACQUELINE (RS5847)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:RS5847
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 SANTO ANTONIO DR STE B
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-8183
Mailing Address - Country:US
Mailing Address - Phone:909-433-9824
Mailing Address - Fax:909-433-9527
Practice Address - Street 1:1076 SANTO ANTONIO DR STE B
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-8183
Practice Address - Country:US
Practice Address - Phone:909-433-9824
Practice Address - Fax:909-433-9527
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)