Provider Demographics
NPI:1447389101
Name:CANTU-REYNA, GUILLERMO ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ALLAN
Last Name:CANTU-REYNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1608
Mailing Address - Country:US
Mailing Address - Phone:619-584-1612
Mailing Address - Fax:619-281-6738
Practice Address - Street 1:217 HIGHLAND AVE
Practice Address - Street 2:FAMILY PRACTICE
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-1518
Practice Address - Country:US
Practice Address - Phone:619-434-7308
Practice Address - Fax:619-434-7310
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41375207Q00000X, 207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A413750OtherMEDI-CAL PROVIDER NUMBER
CA00A413750OtherMEDI-CAL PROVIDER NUMBER
CAA41375Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER