Healthcare Provider Details

I. General information

NPI: 1104732197
Provider Name (Legal Business Name): KARLA REYNOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S GRANADA AVE
ALHAMBRA CA
91801-4021
US

IV. Provider business mailing address

100 S GRANADA AVE
ALHAMBRA CA
91801-4021
US

V. Phone/Fax

Practice location:
  • Phone: 626-943-3613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: