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NPI Code Detail

MEDICARE: PAULINA IVETTE REYNOSA RODRIGUEZ

MEDICARE: PAULINA IVETTE REYNOSA RODRIGUEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner95038224CA

General Provider Information

NPI Number : 1457219669
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULINA IVETTE REYNOSA RODRIGUEZ
Provider Business Mailing Address
First Line : 2685 FOGHORN CV
Second Line :
City : PORT HUENEME
State : CA
Zip : 93041-1550
Country : US
Telephone Number : 805-302-0399
Fax Number :
Provider Business Practice Location Address
First Line : 2685 FOGHORN CV
Second Line :
City : PORT HUENEME
State : CA
Zip : 93041-1550
Country : US
Telephone Number : 805-302-0399
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ PAULINA IVETTE REYNOSA RODRIGUEZ ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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