Doctor Name: | KIM MARIE REYES |
NPI Number: | 1548203748 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | G071574 |
Business Practice Address: | 10063 Riverside Dr Locum Tenens Physician, 2127 Toluca Lake, CA - 916022515 |
Business Phone Number: | 8183783978 |
Business Fax Number: | |
Mailing Address: | Po Box 2127, TOLUCA LAKE |
State: | CA |
Postal Code: | 916100127 |
Phone Number: | 8183783978 |
Fax Number: | |
NPI Enumeration Date: | 06/14/2006 |
NPI Last Update Date: | 04/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G071574 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |