Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT9214 | CA |
NPI | 1003975715 |
---|---|
Provider Name | Teresa C Reyes |
First Address | Bellflower, CA 90706-2141 |
Second Address | Bellflower, CA 90706-2246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 01/12/2021 |