Provider Demographics
NPI:1780741330
Name:REYES, GEORGE DELFIN (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:DELFIN
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 E FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2026
Mailing Address - Country:US
Mailing Address - Phone:619-470-4321
Mailing Address - Fax:
Practice Address - Street 1:1509 WILSON TERRACE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4007
Practice Address - Country:US
Practice Address - Phone:818-409-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA762262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G585940OtherBLUE SHIELD
CARHL162231OtherDHS RADIOLOGY LICENSE
CAP01086192OtherRAILROAD MEDICARE
CA00A762260Medicaid
CA00A762260Medicaid
CA00A762260Medicaid
CAFC222UMedicare PIN
BR6557310OtherUS DEPT OF JUSTICE DEA