Provider Demographics
NPI:1801543475
Name:MONTOYA, REYNA RENEE
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:RENEE
Last Name:MONTOYA
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 1:331 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5006
Mailing Address - Country:US
Mailing Address - Phone:559-362-0802
Mailing Address - Fax:
Practice Address - Street 1:530 KINGS COUNTY DR
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3579
Practice Address - Country:US
Practice Address - Phone:650-866-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-KFHEIS175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist