Provider Demographics
NPI:1811545445
Name:REYES, MARIA REGINA V
Entity type:Individual
Prefix:
First Name:MARIA REGINA
Middle Name:V
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 1:809 LAUREL ST UNIT 251
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-7715
Mailing Address - Country:US
Mailing Address - Phone:650-394-6563
Mailing Address - Fax:
Practice Address - Street 1:809 LAUREL ST UNIT 251
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-7715
Practice Address - Country:US
Practice Address - Phone:650-394-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122420106H00000X
390200000X
CA136491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program