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General NPI Number Information
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NPI Number | 1902162159
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Entity Type | Individual
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Provider Name | GABRIELA REYNOSO VILLAVICENCIO
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Gender | Female
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 17800 WOODRUFF AVE STE F
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City | BELLFLOWER
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State | CA
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Zip | 90706-7080
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Country | US
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Telephone | 562-866-8956
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Fax | 562-866-4158
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Provider Business Mailing Address
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Address Line | 670 PROSPECT AVE
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City | LONG BEACH
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State | CA
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Zip | 90814-1814
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Country | US
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Telephone | 562-746-2666
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 105998
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License Number State | CA
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