Mia Carmen Reyes

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1401 S Grand Ave
Los Angeles, CA 90015-3010

Phone

(213) 748-2411

NPI assigned

Jan 3, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Golden State Emergency Physicians Inc

  • Emergency Medicine Physician
  • Los Angeles, CA
  • NPI 1770886558
  Medicare reassignment

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

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1407517493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 S JUANITA AVE UNIT A",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773438",
            "telephone_number": "310-292-1835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S GRAND AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153010",
            "telephone_number": "213-748-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYES",
        "first_name": "MIA",
        "middle_name": "CARMEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-03",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Del Carmen Reyes, R.N., FNP
• Martin Reyes
• Maryury A Reyes
• Mayra Reyes
• Melissa Reyes
• Michael Reyes, RN
• Michelle Reyes
• Miles Perez Reyes, MD
• Nancy M Reyes, LVN
• Nicolas Reyes

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.