Individual
SUMMER MARIANA REYNOSO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1827 NE 44TH AVE, PORTLAND, OR 97213-1443
(503) 963-6494
Mailing address
5435 BALBOA BLVD STE 202, ENCINO, CA 91316-1570
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10248344
OR
Other
Enumeration date
10/15/2024
Last updated
10/16/2024
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