Provider Demographics
NPI:1790520765
Name:REYES, ANN MARIELLE REYES (NP)
Entity type:Individual
Prefix:MRS
First Name:ANN MARIELLE
Middle Name:REYES
Last Name:REYES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 S SHIELDS DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2022
Mailing Address - Country:US
Mailing Address - Phone:714-316-3720
Mailing Address - Fax:
Practice Address - Street 1:17785 CENTER COURT DR N
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8573
Practice Address - Country:US
Practice Address - Phone:323-446-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner