Provider Demographics
NPI:1750896544
Name:REYES, JOHNNY ABEL
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:ABEL
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 1:3826 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4451
Mailing Address - Country:US
Mailing Address - Phone:424-213-3372
Mailing Address - Fax:
Practice Address - Street 1:14234 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-2449
Practice Address - Country:US
Practice Address - Phone:424-213-3372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management