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General NPI Number Information
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NPI Number | 1134419526
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Entity Type | Individual
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Provider Name | MS. MALI M REYNOSO
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Gender | Female
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 3576 ARLINGTON AVE STE 303
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City | RIVERSIDE
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State | CA
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Zip | 92506-3988
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Country | US
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Telephone | 909-578-0423
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Fax |
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Provider Business Mailing Address
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Address Line | 12350 EYRE CT
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City | MORENO VALLEY
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State | CA
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Zip | 92557-7739
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Country | US
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Telephone | 951-230-5511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 119885
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License Number State | CA
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