Healthcare Provider Details

I. General information

NPI: 1144183203
Provider Name (Legal Business Name): REYNOLD ZOLETA MSN, RN, ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 N RIMSDALE AVE APT 108
COVINA CA
91722-3555
US

IV. Provider business mailing address

688 N RIMSDALE AVE APT 108
COVINA CA
91722-3555
US

V. Phone/Fax

Practice location:
  • Phone: 626-617-4152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number95036260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: