Provider Demographics
NPI:1831487669
Name:REYNA, YALITTZA
Entity type:Individual
Prefix:
First Name:YALITTZA
Middle Name:
Last Name:REYNA
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:PO BOX 1585
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-1585
Mailing Address - Country:US
Mailing Address - Phone:909-307-4465
Mailing Address - Fax:
Practice Address - Street 1:10832 LAUREL ST STE 102
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7688
Practice Address - Country:US
Practice Address - Phone:909-987-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2024-07-05
Deactivation Date:2018-08-24
Deactivation Code:
Reactivation Date:2018-09-06
Provider Licenses
StateLicense IDTaxonomies
CALCSW1052201041C0700X
CAASW783971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical