Healthcare Provider Details

I. General information

NPI: 1760604797
Provider Name (Legal Business Name): MS. REINA A ZELAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 RESEDA BLVD
RESEDA CA
91335-4207
US

IV. Provider business mailing address

6909 RESEDA BLVD
RESEDA CA
91335-4207
US

V. Phone/Fax

Practice location:
  • Phone: 818-343-1813
  • Fax: 818-343-8593
Mailing address:
  • Phone: 818-343-1813
  • Fax: 818-343-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberCL1473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSL5256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: