Healthcare Provider Details

I. General information

NPI: 1659371581
Provider Name (Legal Business Name): TROY MICHAEL REYNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE SUITE 640
ORANGE CA
92868-4300
US

IV. Provider business mailing address

1010 W LA VETA AVE SUITE 640
ORANGE CA
92868-4300
US

V. Phone/Fax

Practice location:
  • Phone: 714-364-4050
  • Fax: 714-364-4051
Mailing address:
  • Phone: 714-364-4050
  • Fax: 714-364-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number6581
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: