Healthcare Provider Details

I. General information

NPI: 1528456050
Provider Name (Legal Business Name): TONI MARIE REYES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1183 E FOOTHILL BLVD STE 135
UPLAND CA
91786-4079
US

IV. Provider business mailing address

1146 SUNSET CT
UPLAND CA
91784-1082
US

V. Phone/Fax

Practice location:
  • Phone: 909-931-1368
  • Fax:
Mailing address:
  • Phone: 909-969-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: