Provider Demographics
NPI:1659371581
Name:REYNA, TROY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:MICHAEL
Last Name: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 1:1010 W LA VETA AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4300
Mailing Address - Country:US
Mailing Address - Phone:714-364-4050
Mailing Address - Fax:714-364-4051
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:SUITE 640
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4300
Practice Address - Country:US
Practice Address - Phone:714-364-4050
Practice Address - Fax:714-364-4051
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65812086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0020193396Medicaid
NVF50909Medicare UPIN