Healthcare Provider Details

I. General information

NPI: 1972812048
Provider Name (Legal Business Name): VANESSA REYNOLDS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10662 1/2 CHESTNUT ST
LOS ALAMITOS CA
90720-2135
US

IV. Provider business mailing address

10662 1/2 CHESTNUT ST
LOS ALAMITOS CA
90720-2135
US

V. Phone/Fax

Practice location:
  • Phone: 562-225-5559
  • Fax: 562-225-5559
Mailing address:
  • Phone: 562-225-5559
  • Fax: 562-309-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number198022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: