Provider Demographics
NPI:1912928540
Name:BERNARDITA DE LOS REYES, M.D., INC.
Entity Type:Organization
Organization Name:BERNARDITA DE LOS REYES, M.D., INC.
Other - Org Name:CLINICA SANTA ISABEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARDITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE LOS REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-587-2222
Mailing Address - Street 1:2760 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5747
Mailing Address - Country:US
Mailing Address - Phone:323-587-2222
Mailing Address - Fax:323-587-3963
Practice Address - Street 1:2760 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5747
Practice Address - Country:US
Practice Address - Phone:323-587-2222
Practice Address - Fax:323-587-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37605363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0088070Medicaid
CAGR0088070Medicaid