MEDICARE: AZEL GIZELLE REYNOZO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95036199	CA

General Provider Information

NPI Number	:	1396603601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZEL GIZELLE REYNOZO NP

Provider Business Mailing Address
First Line	:	1711 W TEMPLE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7329
Country	:	US
Telephone Number	:	213-989-6100
Fax Number	:	213-484-3552

Provider Business Practice Location Address
First Line	:	1711 W TEMPLE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7329
Country	:	US
Telephone Number	:	213-989-6100
Fax Number	:	213-484-3552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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