Healthcare Provider Details

I. General information

NPI: 1790209245
Provider Name (Legal Business Name): REYNA VALENZUELA CEDENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 ROSEMEAD BLVD STE 200
EL MONTE CA
91731-2830
US

IV. Provider business mailing address

1502 W WEST COVINA PKWY
WEST COVINA CA
91790-2703
US

V. Phone/Fax

Practice location:
  • Phone: 626-227-7014
  • Fax:
Mailing address:
  • Phone: 626-960-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number77786
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100295
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: