Provider Demographics
NPI:1457196164
Name:ADORACION REYES MD A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:ADORACION REYES MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-310-6703
Mailing Address - Street 1:11618 SOUTH ST STE 214
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-6618
Mailing Address - Country:US
Mailing Address - Phone:562-310-6703
Mailing Address - Fax:
Practice Address - Street 1:11618 SOUTH ST STE 214
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-6618
Practice Address - Country:US
Practice Address - Phone:562-310-6703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty