Provider Information for 1194920983
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Mr. JOSE REY MFT
Sex: Male
NPI: 1194920983
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1194920983 | ||||||||
| Enumeration Date | 2007-06-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1603 LYMAN PL APT 1 LOS ANGELES, CA 90027-5438 United States Phone: 310-517-4378 | Fax: | ||||||||
| Primary Practice Address | 2081 PALOS VERDES DR N LOMITA, CA 90717-3701 United States Phone: 310-517-4378 | Fax: | ||||||||
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