Individual
MARLON ROA REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN PMHNP-BC
Contact information
Practice address
1225 W 190TH ST STE 280, GARDENA, CA 90248-4305
(310) 515-8113
(310) 538-2102
Mailing address
304 S JONES BLVD # 1109, LAS VEGAS, NV 89107-2623
(702) 840-8518
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
11019279
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
852172
NV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95020637
CA
Other
Enumeration date
04/11/2022
Last updated
06/02/2023
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