Provider Demographics
NPI:1447552229
Name:REYES, LYDIA A (NP)
Entity type:Individual
Prefix:MISS
First Name:LYDIA
Middle Name:A
Last Name:REYES
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:840 TOWNE CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1550
Mailing Address - Fax:909-398-1488
Practice Address - Street 1:8330 RED OAK STREET STE 101
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0603
Practice Address - Country:US
Practice Address - Phone:909-987-4922
Practice Address - Fax:909-466-1190
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2018-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily