Healthcare Provider Details

I. General information

NPI: 1891599197
Provider Name (Legal Business Name): CARLOS TONY REZA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 E HIGHLAND AVE
PATTON CA
92369-7813
US

IV. Provider business mailing address

10327 LAKE SUMMIT DR
MORENO VALLEY CA
92557-2911
US

V. Phone/Fax

Practice location:
  • Phone: 909-672-6038
  • Fax:
Mailing address:
  • Phone: 909-994-9832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: