Individual
GERALDINO REYES FELICIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2640 INDUSTRY WAY, LYNWOOD, CA 90262-4284
(310) 639-5983
Mailing address
2640 INDUSTRY WAY, LYNWOOD, CA 90262-4284
(310) 639-5983
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 30172
CA
Other
Enumeration date
06/11/2013
Last updated
06/18/2013
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