MEDICARE: TIMOTHY NICHOLAS REYNA

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	106S00000X	Behavior Technician	00985637	CA

General Provider Information

NPI Number	:	1558225516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY NICHOLAS REYNA

Provider Business Mailing Address
First Line	:	7383 JOSHUA LN
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92284-7902
Country	:	US
Telephone Number	:	760-288-1123
Fax Number	:	760-288-1123

Provider Business Practice Location Address
First Line	:	39249 LEOPARD ST
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-1146
Country	:	US
Telephone Number	:	760-288-1123
Fax Number	:	760-288-1123

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ TIMOTHY NICHOLAS REYNA ” Practice Location

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