Provider Demographics
NPI:1790580256
Name:REYNA, ESTEBAN
Entity type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:
Last Name:REYNA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:WEST WENDOVER
Mailing Address - State:NV
Mailing Address - Zip Code:89883-4105
Mailing Address - Country:US
Mailing Address - Phone:206-940-4754
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 4105
Practice Address - Street 2:
Practice Address - City:WEST WENDOVER
Practice Address - State:NV
Practice Address - Zip Code:89883-4105
Practice Address - Country:US
Practice Address - Phone:206-940-4754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC7600171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter