Provider Demographics
NPI:1649930850
Name:REYES, BEATRIZ ALYSSON
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:ALYSSON
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7956 HESPERIA AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2113
Mailing Address - Country:US
Mailing Address - Phone:818-447-6239
Mailing Address - Fax:
Practice Address - Street 1:7956 HESPERIA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2113
Practice Address - Country:US
Practice Address - Phone:818-447-6239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician