Basic Information
| Provider Information | |||||||||
| NPI: | 1033651310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | KARLA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | COCA | ||||||||
| OtherFirstName: | KARLA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10417 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932411726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618455100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7839 BURGUNDY AVE | ||||||||
| Address2: | |||||||||
| City: | LAMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932411338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618455100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2016 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 108201 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 126035 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.