Healthcare Provider Details

I. General information

NPI: 1518614684
Provider Name (Legal Business Name): REYNA BUZON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 COLORADO AVE BLDG 2
TURLOCK CA
95382-2706
US

IV. Provider business mailing address

1801 COLORADO AVE STE 320
TURLOCK CA
95382-2708
US

V. Phone/Fax

Practice location:
  • Phone: 209-216-3360
  • Fax:
Mailing address:
  • Phone: 209-216-3360
  • Fax: 209-216-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: