Healthcare Provider Details

I. General information

NPI: 1821933714
Provider Name (Legal Business Name): REINA LAMORENA RENIO AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 EAGLE PEAK CT
CHULA VISTA CA
91910-6821
US

IV. Provider business mailing address

1439 EAGLE PEAK CT
CHULA VISTA CA
91910-6821
US

V. Phone/Fax

Practice location:
  • Phone: 323-804-2671
  • Fax:
Mailing address:
  • Phone: 323-804-2671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG03260089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: