Provider Demographics
NPI:1023134772
Name:REYES, ASUNCION GARCIA
Entity type:Individual
Prefix:
First Name:ASUNCION
Middle Name:GARCIA
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 1:5255 W SUNSET BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5716
Mailing Address - Country:US
Mailing Address - Phone:323-669-3033
Mailing Address - Fax:323-669-3028
Practice Address - Street 1:5255 W SUNSET BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5716
Practice Address - Country:US
Practice Address - Phone:323-669-3033
Practice Address - Fax:323-669-3028
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA521265Medicare UPIN