Healthcare Provider Details

I. General information

NPI: 1396343224
Provider Name (Legal Business Name): ALEXANDRA REYES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71843 HIGHWAY 111 STE B
RANCHO MIRAGE CA
92270-4418
US

IV. Provider business mailing address

5236 GODINEZ DR
FONTANA CA
92336-4624
US

V. Phone/Fax

Practice location:
  • Phone: 626-806-9024
  • Fax: 877-646-8688
Mailing address:
  • Phone: 626-806-9024
  • Fax: 877-646-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014726
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95014726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: