Healthcare Provider Details

I. General information

NPI: 1023981313
Provider Name (Legal Business Name): RENEE ANGELA DYKES LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14075 HESPERIA RD STE 106
VICTORVILLE CA
92395-4500
US

IV. Provider business mailing address

3031 MOUNTAIN TOP DR
HIGHLAND CA
92346-4848
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-1078
  • Fax:
Mailing address:
  • Phone: 909-708-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number267763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: