MEDICARE: MRS. HAZEL ANN RONA REYES MSC, MN, RN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NPF95000714	CA

General Provider Information

NPI Number	:	1508278326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HAZEL ANN RONA REYES MSC, MN, RN, FNP-C

Provider Business Mailing Address
First Line	:	3361 BLISS CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5252
Country	:	US
Telephone Number	:	951-454-0961
Fax Number	:

Provider Business Practice Location Address
First Line	:	3361 BLISS CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5252
Country	:	US
Telephone Number	:	951-454-0961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2014
Last Update Date	:	06/21/2016

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