Healthcare Provider Details

I. General information

NPI: 1982900171
Provider Name (Legal Business Name): JOEL FLAVIANO REYNOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12440 E . FIRESTONE BLVD SUITE 1000
NORWALK CA
90650
US

IV. Provider business mailing address

12440 E . FIRESTONE BLVD SUITE 1000
NORWALK CA
90650
US

V. Phone/Fax

Practice location:
  • Phone: 562-864-3722
  • Fax: 562-864-4596
Mailing address:
  • Phone: 562-864-3722
  • Fax: 562-864-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: