Provider Demographics
NPI:1447055355
Name:WHITEHEAD, REGINALD DEON II
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:DEON
Last Name:WHITEHEAD
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 COLLEGE NINE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95064-1100
Mailing Address - Country:US
Mailing Address - Phone:209-273-9250
Mailing Address - Fax:
Practice Address - Street 1:7800 ARROYO CIR STE B
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7346
Practice Address - Country:US
Practice Address - Phone:877-910-6538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician