NPIMap

Individual provider Active NPI

Kenneth Baldemor Reyes, FNP-BC

  • Family Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1083907547
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95018998 Issued in CA
Practice address
438 Camino del Rio S Ste 203
San Diego, CA 92108-3546
Phone
(619) 955-8507
Fax
(619) 955-8508
NPI assigned
May 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95043997 CA
Licensed Vocational Nurse 164X00000X 223137 CA
Family Nurse Practitioner 363LF0000X 95018998 CA Primary

Addresses

Primary practice location

438 Camino del Rio S Ste 203
San Diego, CA 92108-3546

Mailing address

438 Camino del Rio S Ste 203
San Diego, CA 92108-3546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230516003646 CA Practitioner - Nurse Practitioner 9133585185 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
National Medical University, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ardent Medical Group PCGroup PAC ID 8123546454, 2 clinicians

Practice addresses (Care Compare)

809 Bowsprit Rd
Suite 207
Chula Vista, CA 91914-4527
Phone (619) 993-7743

Hospital & facility affiliations

  • Running River Home Health Services Home health agency, Cerritos, CA, CCN 559064
  • Saint Victoria Home Health Care Home health agency, North Hollywood, CA, CCN 757646
  • Sacred Heart Health Care Providers Inc Home health agency, El Cajon, CA, CCN 059483
  • Primary Care Homehealthcare Inc Home health agency, Van Nuys, CA, CCN 559298
  • Mission Home Health of San Diego LLC Home health agency, San Diego, CA, CCN 557711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95043997CAMDRegistered Nurse
223137CAMDLicensed Vocational Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
LF Capital Inc Family CurrentSince Apr 1, 2023 Accepting new patients
Ardent Medical Group PC CurrentSince Apr 19, 2025 Accepting new patients
Community Research Foundation Inc Past Accepting new patients
Community Research Foundation Inc Past Accepting new patients
Reliable Care Medical Group AMC PC PastSince Apr 10, 2022 Accepting new patients

Locations

809 Bowsprit Rd
Ste 207
Chula Vista, CA 91914
Phone (310) 418-4745

438 Camino del Rio S
Ste 203
San Diego, CA 92108
Phone (619) 955-8507

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1083907547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "438 CAMINO DEL RIO S STE 203",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 CAMINO DEL RIO S STE 203",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083546",
            "telephone_number": "619-955-8507",
            "fax_number": "619-955-8508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYES",
        "first_name": "KENNETH",
        "middle_name": "BALDEMOR",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-17",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95043997",
            "primary": false
        },
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "223137",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95018998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.