Provider Demographics
NPI:1902054919
Name:REYES, ROMI ERNEST
Entity Type:Individual
Prefix:MR
First Name:ROMI
Middle Name:ERNEST
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 N SAN GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2939
Mailing Address - Country:US
Mailing Address - Phone:626-482-4997
Mailing Address - Fax:
Practice Address - Street 1:513 N SAN GABRIEL AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2939
Practice Address - Country:US
Practice Address - Phone:626-482-4997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health