Provider Demographics
NPI:1346938628
Name:REANO, DESIREE ANGULO
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:ANGULO
Last Name:REANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 PRINCESS DIANA CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8558
Mailing Address - Country:US
Mailing Address - Phone:415-806-1075
Mailing Address - Fax:
Practice Address - Street 1:7611 PRINCESS DIANA CT
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8558
Practice Address - Country:US
Practice Address - Phone:415-806-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA726246164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse