Provider Demographics
NPI:1205977246
Name:REYES, JOY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6418 E RAVEN CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4398
Mailing Address - Country:US
Mailing Address - Phone:714-532-3492
Mailing Address - Fax:562-867-7146
Practice Address - Street 1:17620 BELLFLOWER BLVD STE B106
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-8001
Practice Address - Country:US
Practice Address - Phone:562-867-7098
Practice Address - Fax:562-867-7146
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9013363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP9013OtherNURSE PRACTITIONER