MEDICARE: MACY JORDAN REZA

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1720824352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACY JORDAN REZA

Provider Business Mailing Address
First Line	:	4373 BARDINI WAY
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95382-7238
Country	:	US
Telephone Number	:	209-535-5298
Fax Number	:

Provider Business Practice Location Address
First Line	:	2043 COLLEGE WAY
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1797
Country	:	US
Telephone Number	:	503-352-6151
Fax Number	:

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	12/01/2025

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Directions to “ MACY JORDAN REZA ” Practice Location

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