Provider Demographics
NPI:1336840974
Name:REYNA-GONZALEZ, SAMANTHA MICHELLE (WCC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MICHELLE
Last Name:REYNA-GONZALEZ
Suffix:
Gender:F
Credentials:WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10129 GOOSE BERRY PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2652
Mailing Address - Country:US
Mailing Address - Phone:907-250-0458
Mailing Address - Fax:
Practice Address - Street 1:4160 TUDOR CENTRE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5901
Practice Address - Country:US
Practice Address - Phone:907-729-6365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator