Mary Irene Gonzales Rey, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

21825 Issued in CA

Practice address

4950 Barranca Pkwy Ste 104
Irvine, CA 92604-8644

Phone

(949) 857-1248

Fax

(949) 559-1165

NPI assigned

Jul 13, 2011

Last updated

Sep 25, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mary Irene Gonzales Miranda Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mmiranda111268@direct.memorialcare.org

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

• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Colton, CA
  • NPI 1306899166
  NPD (past)
• Front Line Emergency Care Spec

  • Emergency Medicine Physician
  • Lynwood, CA
  • NPI 1366451080
  NPD (past)

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

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1770871576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3699",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926598699",
            "telephone_number": "657-241-3600",
            "fax_number": "657-241-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 BARRANCA PKWY STE 104",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926048644",
            "telephone_number": "949-857-1248",
            "fax_number": "949-559-1165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18785 Brookhurst St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Fountain Valley",
            "state": "CA",
            "postal_code": "927087300",
            "country_code": "US",
            "telephone_number": "714-378-0042",
            "fax_number": "714-968-9129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REY",
        "first_name": "MARY IRENE",
        "middle_name": "GONZALES",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-13",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "21825",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "16685",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P01319747",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CB275687",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY IRENE",
            "last_name": "MIRANDA",
            "middle_name": "GONZALES",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Anusha Revuri
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• Alfonso Reyes
• Jennilee Reyes, DPT
• Joseph Reyes
• Justin Dale Reyes, FNP

• Physician Assistant in Irvine, CA
• Providers in Irvine, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.