Provider Demographics
NPI:1124896261
Name:REYNA, JESSE THUNDERHAWK (RADT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:THUNDERHAWK
Last Name:REYNA
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CLOVERBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-7353
Mailing Address - Country:US
Mailing Address - Phone:925-354-9755
Mailing Address - Fax:
Practice Address - Street 1:217 CLOVERBROOK CIR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-7353
Practice Address - Country:US
Practice Address - Phone:925-354-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)