Provider Demographics
NPI:1962983080
Name:REYES, RUBI
Entity type:Individual
Prefix:
First Name:RUBI
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 1:48037 ESTRELLA TOMAS
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-6307
Mailing Address - Country:US
Mailing Address - Phone:760-574-3522
Mailing Address - Fax:
Practice Address - Street 1:48037 ESTRELLA TOMAS
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-6307
Practice Address - Country:US
Practice Address - Phone:760-574-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010300225X00000X
CA16189225X00000X
HIOT-1729225X00000X
OR354733225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist