Provider Demographics
NPI:1760729891
Name:REAY, JENOICE S
Entity Type:Individual
Prefix:
First Name:JENOICE
Middle Name:S
Last Name:REAY
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 1:32770 OLD WOMAN SPRINGS RD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:LUCERNE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32770 OLD WOMAN SPRINGS RD.
Practice Address - Street 2:SUITE C
Practice Address - City:LUCERNE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92356
Practice Address - Country:US
Practice Address - Phone:760-248-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator