Provider Demographics
NPI:1427659754
Name:REYES, JUSTIN DALE (FNP)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DALE
Last Name:REYES
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:1 HOAG DRIVE
Mailing Address - Street 2:CANCER CENTER- BUILDING 41, FLOOR 3, SUITE 107
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5684
Mailing Address - Country:US
Mailing Address - Phone:949-764-1954
Mailing Address - Fax:949-764-5607
Practice Address - Street 1:1 HOAG DRIVE
Practice Address - Street 2:CANCER CENTER- BUILDING 41, FLOOR 3, SUITE 107
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5684
Practice Address - Country:US
Practice Address - Phone:949-764-1954
Practice Address - Fax:949-764-5607
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2021-05-12
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Provider Licenses
StateLicense IDTaxonomies
CACA95015495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily