Healthcare Provider Details

I. General information

NPI: 1598689549
Provider Name (Legal Business Name): ISAAC REYES HERRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N CARPENTER RD STE C19
MODESTO CA
95351-1156
US

IV. Provider business mailing address

4732 DAHLIA DR
STOCKTON CA
95212-2118
US

V. Phone/Fax

Practice location:
  • Phone: 209-988-5141
  • Fax:
Mailing address:
  • Phone: 209-898-4527
  • 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: