Healthcare Provider Details

I. General information

NPI: 1023617982
Provider Name (Legal Business Name): ROSALINDA JUANITA REYNAGA X
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 S CHERRY AVE
FRESNO CA
93706-5445
US

IV. Provider business mailing address

2960 S CHERRY AVE
FRESNO CA
93706-5445
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-6107
  • Fax: 559-265-6193
Mailing address:
  • Phone: 559-265-6107
  • Fax: 559-265-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE124983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: