Healthcare Provider Details

I. General information

NPI: 1457256349
Provider Name (Legal Business Name): GENUINE REYES GATCHALIAN ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 BOWER PL
LEONA VALLEY CA
93551-6174
US

IV. Provider business mailing address

2728 BOWER PL
LEONA VALLEY CA
93551-6174
US

V. Phone/Fax

Practice location:
  • Phone: 818-437-1291
  • Fax:
Mailing address:
  • Phone: 818-437-1291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95041927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: