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General NPI Number Information
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NPI Number | 1093461543
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Entity Type | Individual
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Provider Name | GERARDO REYNAGA GONZALEZ
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Gender | Male
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 2168 LA MIRADA DR
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City | EL SOBRANTE
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State | CA
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Zip | 94803-3216
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Country | US
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Telephone | 510-504-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 1556 FITZGERALD DR # 116
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City | PINOLE
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State | CA
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Zip | 94564-2229
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Country | US
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Telephone | 510-504-3005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 876
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License Number State | CA
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