Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 95006656 | CA |
N | 363LA2100X | Nurse Practitioner - Acute Care | 95006656 | CA |
N | 363LC1500X | Nurse Practitioner - Community Health | 95006656 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95006656 | CA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95006656 | CA |
NPI | 1952800781 |
---|---|
Provider Name | Rene Reyna-Tobar |
First Address | Sacramento, CA 95835-2164 |
Second Address | Sacramento, CA 95811-0110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2018 |
Last Update Date | 09/12/2019 |