Provider Demographics
NPI:1255463220
Name:REYES, HECTOR-JOSE BORGES
Entity type:Individual
Prefix:MR
First Name:HECTOR-JOSE
Middle Name:BORGES
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 ALPINE ST APT 109
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-6404
Mailing Address - Country:US
Mailing Address - Phone:626-824-6088
Mailing Address - Fax:
Practice Address - Street 1:1224 E LOWELL ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-3801
Practice Address - Country:US
Practice Address - Phone:520-621-3334
Practice Address - Fax:520-626-6105
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZLCSW-185731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program