Provider Demographics
NPI:1154087187
Name:KIRALY, RENA YVONNE (NP)
Entity Type:Individual
Prefix:MS
First Name:RENA
Middle Name:YVONNE
Last Name:KIRALY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RENA
Other - Middle Name:YVONNE
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:19947 WINDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-8901
Mailing Address - Country:US
Mailing Address - Phone:209-327-0021
Mailing Address - Fax:209-368-6425
Practice Address - Street 1:900 S FAIRMONT AVE STE A
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5143
Practice Address - Country:US
Practice Address - Phone:209-333-2500
Practice Address - Fax:209-333-3377
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily