Provider Demographics
NPI:1326064189
Name:DR. ANA R REYNA A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. ANA R REYNA A PROFESSIONAL CORPORATION
Other - Org Name:DR. ANA R REYNA A PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-822-3519
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-2029
Mailing Address - Country:US
Mailing Address - Phone:661-335-7755
Mailing Address - Fax:661-335-7766
Practice Address - Street 1:20111 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561
Practice Address - Country:US
Practice Address - Phone:661-822-3519
Practice Address - Fax:661-822-3528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G515580Medicaid
CA00G515580Medicaid