Provider Demographics
NPI:1285136689
Name:REYES, DENICE
Entity type:Individual
Prefix:
First Name:DENICE
Middle Name:
Last Name:REYES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33568
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3568
Mailing Address - Country:US
Mailing Address - Phone:855-223-7123
Mailing Address - Fax:619-550-6368
Practice Address - Street 1:39899 BALENTINE DR STE 110
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5356
Practice Address - Country:US
Practice Address - Phone:855-223-7123
Practice Address - Fax:619-550-6368
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARBT-17-36954OtherBEHAVIOR ANALYST CERTIFICATION BOARD