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General NPI Number Information
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NPI Number | 1558225516
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Entity Type | Individual
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Provider Name | TIMOTHY NICHOLAS REYNA
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Gender | Male
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 39249 LEOPARD ST
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City | PALM DESERT
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State | CA
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Zip | 92211-1146
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Country | US
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Telephone | 760-288-1123
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Fax | 760-288-1123
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Provider Business Mailing Address
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Address Line | 7383 JOSHUA LN
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-7902
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Country | US
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Telephone | 760-288-1123
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Fax | 760-288-1123
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 00985637
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License Number State | CA
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