Provider Demographics
NPI:1295720316
Name:REYES, JOAQUIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3838 SHERMAN DR
Mailing Address - Street 2:SUITE # 203
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4001
Mailing Address - Country:US
Mailing Address - Phone:951-785-6767
Mailing Address - Fax:951-785-6783
Practice Address - Street 1:3838 SHERMAN DR
Practice Address - Street 2:SUITE # 203
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4001
Practice Address - Country:US
Practice Address - Phone:951-785-6767
Practice Address - Fax:951-785-6783
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA77434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH99399Medicare UPIN