Provider Demographics
NPI:1063399608
Name:REYES, AIMEE CRYSTELLE
Entity type:Individual
Prefix:
First Name:AIMEE CRYSTELLE
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9936 RESEDA BLVD UNIT 36
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-1514
Mailing Address - Country:US
Mailing Address - Phone:818-294-9068
Mailing Address - Fax:
Practice Address - Street 1:9936 RESEDA BLVD UNIT 36
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-1514
Practice Address - Country:US
Practice Address - Phone:818-294-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31950124Q00000X
CA1147124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist