Provider Demographics
NPI:1447332911
Name:REYES, ANTHONY JR (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:REYES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90609-1277
Mailing Address - Country:US
Mailing Address - Phone:562-906-6470
Mailing Address - Fax:562-946-9465
Practice Address - Street 1:12675 LA MIRADA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2200
Practice Address - Country:US
Practice Address - Phone:562-903-7339
Practice Address - Fax:562-944-8631
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH86081Medicare UPIN
CAWA66936BMedicare PIN