Provider Demographics
NPI:1801281639
Name:JORGE REYES
Entity type:Organization
Organization Name:JORGE REYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:213-458-1459
Mailing Address - Street 1:25453 VIA LABRADA
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2718
Mailing Address - Country:US
Mailing Address - Phone:213-458-1459
Mailing Address - Fax:661-430-5414
Practice Address - Street 1:23550 LYONS AVE
Practice Address - Street 2:STE 211
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2520
Practice Address - Country:US
Practice Address - Phone:661-360-6792
Practice Address - Fax:661-430-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 27150302F00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization