Provider Demographics
NPI:1942933460
Name:REYES, ALEXIS DIZON
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DIZON
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ALEXIS
Other - Middle Name:DIZON
Other - Last Name:CASILANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2171 S GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-4600
Mailing Address - Country:US
Mailing Address - Phone:909-923-4080
Mailing Address - Fax:
Practice Address - Street 1:2171 S GROVE AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-4600
Practice Address - Country:US
Practice Address - Phone:909-923-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95153806163W00000X
CA95022212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse