Individual provider Active NPI

Justin Carl Reyes Torres, NP

  • Gerontology Nurse Practitioner
  • Lynwood, CA
National Provider Identifier
1619825965
Registry record updated Mar 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
95036724 Issued in CA
Practice address
3621 Martin Luther King Jr Blvd Ste 6
Lynwood, CA 90262-3512
Phone
(310) 638-9977
Fax
(310) 638-8615
NPI assigned
Mar 20, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 95036724 CA Primary

Addresses

Primary practice location

3621 Martin Luther King Jr Blvd Ste 6
Lynwood, CA 90262-3512

Mailing address

3621 Martin Luther King Jr Blvd Ste 6
Lynwood, CA 90262-3512
Phone (310) 638-9977

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95036724CAMDGerontology Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1773964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773964800000",
    "number": "1619825965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 MARTIN LUTHER KING JR BLVD STE 6",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902623512",
            "telephone_number": "310-638-9977",
            "fax_number": "310-638-8615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3621 MARTIN LUTHER KING JR BLVD STE 6",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902623512",
            "telephone_number": "310-638-9977",
            "fax_number": "310-638-8615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TORRES",
        "first_name": "JUSTIN CARL",
        "middle_name": "REYES",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-03-20",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95036724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynwood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.