Healthcare Provider Details

I. General information

NPI: 1558259424
Provider Name (Legal Business Name): REINA ESCOVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 POMONA RD STE 233
CORONA CA
92878-4324
US

IV. Provider business mailing address

1611 POMONA RD STE 233
CORONA CA
92878-4324
US

V. Phone/Fax

Practice location:
  • Phone: 714-926-7708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: