Healthcare Provider Details

I. General information

NPI: 1972184950
Provider Name (Legal Business Name): ANDY PAUL REYNAGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 RED OAK ST STE 201
RANCHO CUCAMONGA CA
91730-0603
US

IV. Provider business mailing address

8330 RED OAK ST STE 201
RANCHO CUCAMONGA CA
91730-0603
US

V. Phone/Fax

Practice location:
  • Phone: 909-987-2528
  • Fax: 909-987-4668
Mailing address:
  • Phone: 909-987-2528
  • Fax: 909-987-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA192967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: