Healthcare Provider Details

I. General information

NPI: 1134038078
Provider Name (Legal Business Name): JENESSA REYES COLOCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 S COUNTRY CLUB DR STE 30
MESA AZ
85210-9700
US

IV. Provider business mailing address

1400 N COOPER RD UNIT 1069
GILBERT AZ
85233-1254
US

V. Phone/Fax

Practice location:
  • Phone: 480-576-9024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: