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NPI Code Detail

MEDICARE: CRYSTAL REYNOSO

MEDICARE: CRYSTAL REYNOSO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1033527379
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL REYNOSO
Provider Business Mailing Address
First Line : 16782 VON KARMAN AVE STE 11
Second Line :
City : IRVINE
State : CA
Zip : 92606-2417
Country : US
Telephone Number : 855-223-7123
Fax Number :
Provider Business Practice Location Address
First Line : 23740 HAWTHORNE BLVD STE 104
Second Line :
City : TORRANCE
State : CA
Zip : 90505-8206
Country : US
Telephone Number : 855-223-7123
Fax Number : 562-698-6613
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2014
Last Update Date : 06/23/2021

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Directions to “ CRYSTAL REYNOSO ” Practice Location

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