Provider Demographics
NPI:1407446297
Name:REYES, REGINA JANE MAYONTE
Entity Type:Individual
Prefix:
First Name:REGINA JANE
Middle Name:MAYONTE
Last Name:REYES
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 1:7221 BERRY CREEK ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9438
Mailing Address - Country:US
Mailing Address - Phone:909-720-2460
Mailing Address - Fax:
Practice Address - Street 1:1150 E ORANGETHORPE AVE STE 107
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5203
Practice Address - Country:US
Practice Address - Phone:714-823-3361
Practice Address - Fax:714-823-3361
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32795235Z00000X
CA15196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty