=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972812048
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA REYNOLDS LVN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2010
-----------------------------------------------------
Last Update Date | 03/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10662 1/2 CHESTNUT ST
-----------------------------------------------------
City | LOS ALAMITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90720-2135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-225-5559
-----------------------------------------------------
Fax | 562-225-5559
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10662 1/2 CHESTNUT ST
-----------------------------------------------------
City | LOS ALAMITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90720-2135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-225-5559
-----------------------------------------------------
Fax | 562-309-9997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | 198022
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------