1326064189 NPI number — DR. ANA R REYNA A PROFESSIONAL CORPORATION

Table of content: (NPI 1326064189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326064189 NPI number — DR. ANA R REYNA A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. ANA R REYNA A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. ANA R REYNA A PROFESSIONAL CORPORATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326064189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93303-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-335-7755
Provider Business Mailing Address Fax Number:
661-335-7766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20111 VALLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-3519
Provider Business Practice Location Address Fax Number:
661-822-3528
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REYNA
Authorized Official First Name:
ANA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
661-822-3519

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G51558 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G515580 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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