MEDICARE: MISS ENEYDA REYNOSO

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1699891689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ENEYDA REYNOSO

Provider Business Mailing Address
First Line	:	3114 E 6TH ST
Second Line	:	APT. 7
City	:	LONG BEACH
State	:	CA
Zip	:	90814-8572
Country	:	US
Telephone Number	:	562-438-7090
Fax Number	:

Provider Business Practice Location Address
First Line	:	8616 LA TIJERA BLVD
Second Line	:	STE. 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3944
Country	:	US
Telephone Number	:	310-337-1886
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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Directions to “ MISS ENEYDA REYNOSO ” Practice Location

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