Healthcare Provider Details

I. General information

NPI: 1992489124
Provider Name (Legal Business Name): YONNAS REGGIANI PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 168
GLENDALE AZ
85308-4624
US

IV. Provider business mailing address

3104 E CAMELBACK RD UNIT 7963
PHOENIX AZ
85016-4502
US

V. Phone/Fax

Practice location:
  • Phone: 844-385-3747
  • Fax:
Mailing address:
  • Phone: 602-492-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-005847
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: