Provider Demographics
NPI:1629213285
Name:REYNA-TERRY, LETICIA ILEANA
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:ILEANA
Last Name:REYNA-TERRY
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 1:1870 N ARROYO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1208
Mailing Address - Country:US
Mailing Address - Phone:626-296-3474
Mailing Address - Fax:
Practice Address - Street 1:1870 N ARROYO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1208
Practice Address - Country:US
Practice Address - Phone:626-296-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 495243163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health