Provider Demographics
NPI:1184106486
Name:REYES, DORA MARTHA (COMMUNITY WORKER)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:MARTHA
Last Name:REYES
Suffix:
Gender:F
Credentials:COMMUNITY WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2803
Mailing Address - Country:US
Mailing Address - Phone:323-478-8200
Mailing Address - Fax:323-344-8829
Practice Address - Street 1:3033 N. BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-4883
Practice Address - Country:US
Practice Address - Phone:323-478-8200
Practice Address - Fax:323-344-8829
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172V00000XOther Service ProvidersCommunity Health Worker