Healthcare Provider Details

I. General information

NPI: 1003210469
Provider Name (Legal Business Name): LAKENYA REESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 E BRIER DR STE 200
SAN BERNARDINO CA
92408-2847
US

IV. Provider business mailing address

658 E BRIER DR STE 200
SAN BERNARDINO CA
92408-2847
US

V. Phone/Fax

Practice location:
  • Phone: 909-501-0700
  • Fax:
Mailing address:
  • Phone: 909-501-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128733
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberD7211097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: