Healthcare Provider Details

I. General information

NPI: 1326064189
Provider Name (Legal Business Name): DR. ANA R REYNA A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20111 VALLEY BLVD
TEHACHAPI CA
93561
US

IV. Provider business mailing address

PO BOX 2029
BAKERSFIELD CA
93303-2029
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-3519
  • Fax: 661-822-3528
Mailing address:
  • Phone: 661-335-7755
  • Fax: 661-335-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG51558
License Number StateCA

VIII. Authorized Official

Name: DR. ANA R REYNA
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 661-822-3519