Healthcare Provider Details

I. General information

NPI: 1255254454
Provider Name (Legal Business Name): YALITZA VALDOVINOS REYNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S 5TH ST
SAN JOSE CA
95112-5636
US

IV. Provider business mailing address

2040 ROCK PINE CT
MODESTO CA
95351-3451
US

V. Phone/Fax

Practice location:
  • Phone: 408-457-6284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number762415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: