Trish Balolong Reyes, NURSE PRACTITIONER
Individual provider Active NPI Family Nurse Practitioner · Westlake Village, CA
NPI 1972002228 · NPPES record last updated May 25, 2021
Key facts
- NPI
- 1972002228
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- NP95009438 (CA)
- Practice address
- 2791 Agoura Rd
Westlake Village, CA 91361-3101 - Phone
- (866) 389-2727
- NPI assigned
- Feb 1, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190208002763 | CA | Practitioner - Nurse Practitioner | 6507104973 | Reassigns benefits to 1 organization |
| I20200727001372 | IL | Practitioner - Nurse Practitioner | 6507104973 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP95009438 | CA | MD | Family Nurse Practitioner |
| NP95909438 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alliance Physician Partners Hospitalist Group LLC | Current |
Accepting new patients | |
| Janesri de Silva M.D. a Prof Corp | Current |
Accepting new patients | |
| Pediatric Affiliates Medical Group Inc | Past | Accepting new patients | |
| Healthylife MG Corp | Past | Accepting new patients |
Locations
1442 Foothill Blvd
La Canada Flintridge, CA 91011
Phone (747) 233-3295
12675 La Mirada Blvd
Ste 200
La Mirada, CA 90638
Phone (562) 941-9853
504 S Sierra Madre Blvd
Pasadena, CA 91107
Phone (626) 795-8811
9525 Mayfield Ave
Oak Lawn, IL 60453
Phone (708) 636-7000
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | NP95909438 | CA | |
| Family Nurse Practitioner | 363LF0000X | NP95009438 | CA | Yes |
Addresses
Primary practice location
2791 Agoura Rd
Westlake Village, CA 91361-3101
Mailing address
2791 Agoura Rd
Westlake Village, CA 91361-3101
Phone (186) 638-9272
Other providers in Westlake Village, CA
- Zulim Melina Renfro
- Mary Resnick
- Retinal Consultants of Southern California Medical Group, Inc
- Kyle Reuser
- Carlo Magno Reyes
- Trevor Reynolds
- Daniel Ernesto Reza
- Sepideh T Rezai
- Jenny Reznick
- Rgac Enterprises, Inc.
All providers in Westlake Village, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.