Healthcare Provider Details

I. General information

NPI: 1366138638
Provider Name (Legal Business Name): REYVIN MACALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 WOODSIDE PLZ
REDWOOD CITY CA
94061-3259
US

IV. Provider business mailing address

343 LINCOLN AVE
ALAMEDA CA
94501-3218
US

V. Phone/Fax

Practice location:
  • Phone: 650-368-7008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number186663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: