Jeremy Hector Reynoso, PTA

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

51014 Issued in CA

Practice address

255 E Rincon St
Corona, CA 92879-1367

Phone

(951) 523-8509

Fax

(951) 221-8475

NPI assigned

Mar 13, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615593600000",
    "number": "1770168536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 MESA DR APT 19",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926600111",
            "telephone_number": "949-259-3921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E RINCON ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928791367",
            "telephone_number": "951-523-8509",
            "fax_number": "951-221-8475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOSO",
        "first_name": "JEREMY",
        "middle_name": "HECTOR",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-13",
        "last_updated": "2021-03-13",
        "certification_date": "2021-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "51014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Corona",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "255 E Rincon St",
            "city": "Corona",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928791367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristyan Alani Reyes
• Roberto Reyes
• Carmen Reyna, ACSW
• Avuse Antionette Reynolds
• Byron Omar Reynoso, D.P.T.
• Karla Reynoso
• Patricia Reynoso
• Brenda Rienru Rhima, NP
• Richard J. Shuldiner, OD, Faao, PC
• Mackenzie Richards

• Physical Medicine & Rehabilitation Physician in Corona, CA
• Providers in Corona, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.