Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 6581 | NV |
NPI | 1659371581 |
---|---|
Provider Name | Troy Michael Reyna |
First Address | Orange, CA 92868-4300 |
Second Address | Orange, CA 92868-4300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 19/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0020193396 | (05) | NV |
F50909 | (02) | NV |