Healthcare Provider Details

I. General information

NPI: 1801543475
Provider Name (Legal Business Name): REYNA RENEE MONTOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 KINGS COUNTY DR
HANFORD CA
93230-3579
US

IV. Provider business mailing address

331 W 2ND ST
HANFORD CA
93230-5006
US

V. Phone/Fax

Practice location:
  • Phone: 650-866-4080
  • Fax:
Mailing address:
  • Phone: 559-362-0802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-KFHEIS
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: