Provider Demographics
NPI:1801912928
Name:REYES, CAROLYN
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
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 1:9300 VALLEY CHILDRENS PL # SC05
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-5700
Mailing Address - Fax:559-353-5708
Practice Address - Street 1:1792 TRIBUTE RD STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4320
Practice Address - Country:US
Practice Address - Phone:916-678-5400
Practice Address - Fax:916-678-7663
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248706207VM0101X
DCMD043821207VM0101X
CAG69577207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW809FMedicare ID - Type UnspecifiedEL MONTE
CAW932Medicare ID - Type UnspecifiedHEALTH CENTER
CAW809AMedicare ID - Type UnspecifiedROYBAL
CAW809BMedicare ID - Type UnspecifiedHUDSON
F96403Medicare UPIN