Provider Demographics
NPI:1033228382
Name:REYES, ATMAN RANII (MD INC)
Entity type:Individual
Prefix:DR
First Name:ATMAN
Middle Name:RANII
Last Name:REYES
Suffix:
Gender:M
Credentials:MD INC
Other - Prefix:DR
Other - First Name:ATMAN
Other - Middle Name:RANII
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:893 PATRIOT DR STE A
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3357
Mailing Address - Country:US
Mailing Address - Phone:805-531-1000
Mailing Address - Fax:805-531-1100
Practice Address - Street 1:893 PATRIOT DR STE A
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3357
Practice Address - Country:US
Practice Address - Phone:805-531-1000
Practice Address - Fax:805-531-1100
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA652932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A652930Medicaid
H33534Medicare UPIN
A65293Medicare ID - Type Unspecified