Provider Demographics
NPI:1316745789
Name:REYNOLDS, LEANNE
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34052 DOHENY PARK RD SPC 128
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92624-3184
Mailing Address - Country:US
Mailing Address - Phone:408-412-2009
Mailing Address - Fax:
Practice Address - Street 1:34052 DOHENY PARK RD SPC 128
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92624-3184
Practice Address - Country:US
Practice Address - Phone:949-441-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304700475251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health