Provider Demographics
NPI:1134961717
Name:FALLORINA, REYSEL (RPH)
Entity type:Individual
Prefix:
First Name:REYSEL
Middle Name:
Last Name:FALLORINA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 MONTEREY HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6149
Mailing Address - Country:US
Mailing Address - Phone:408-378-2363
Mailing Address - Fax:
Practice Address - Street 1:4850 SAN FELIPE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1266
Practice Address - Country:US
Practice Address - Phone:408-532-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2025-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist