Healthcare Provider Details

I. General information

NPI: 1447084249
Provider Name (Legal Business Name): REINA ELVINA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 MARSHALL ST
REDWOOD CITY CA
94063-2503
US

IV. Provider business mailing address

1410 MARSHALL ST
REDWOOD CITY CA
94063-2503
US

V. Phone/Fax

Practice location:
  • Phone: 650-578-8691
  • Fax:
Mailing address:
  • Phone: 650-931-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number742228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: