Provider Demographics
NPI:1871604694
Name:REYES, ANTONIO TENORIO (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:TENORIO
Last Name:REYES
Suffix:
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 1:408 S BEACH BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1853
Mailing Address - Country:US
Mailing Address - Phone:714-826-8800
Mailing Address - Fax:714-226-9760
Practice Address - Street 1:408 S BEACH BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1853
Practice Address - Country:US
Practice Address - Phone:714-826-8800
Practice Address - Fax:714-226-9760
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A50615OtherMEDICAL PROVIDER NO.
CA00A50615OtherMEDICAL PROVIDER NO.