Provider Demographics
NPI:1992092407
Name:REYES, ELSA
Entity type:Individual
Prefix:
First Name:ELSA
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 1:1510 PARKMOOR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2418
Mailing Address - Country:US
Mailing Address - Phone:408-673-3737
Mailing Address - Fax:408-673-3820
Practice Address - Street 1:1510 PARKMOOR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2418
Practice Address - Country:US
Practice Address - Phone:408-673-3737
Practice Address - Fax:408-673-3820
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator