Provider Demographics
NPI:1538905526
Name:REYES, ANGELA S (MT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:REYES
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31489 AMSTERDAM RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-9256
Mailing Address - Country:US
Mailing Address - Phone:619-272-1134
Mailing Address - Fax:
Practice Address - Street 1:24619 WASHINGTON AVE STE 206
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8228
Practice Address - Country:US
Practice Address - Phone:951-698-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist