Healthcare Provider Details

I. General information

NPI: 1568049492
Provider Name (Legal Business Name): DEBORAH SUSAN REYNA MSW, MA, BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 06/16/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 CASSIDY ST
OCEANSIDE CA
92054-5314
US

IV. Provider business mailing address

321 CASSIDY ST
OCEANSIDE CA
92054-5314
US

V. Phone/Fax

Practice location:
  • Phone: 760-721-2171
  • Fax: 760-721-8582
Mailing address:
  • Phone: 760-721-2171
  • Fax: 760-439-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: