Individual
STEPHANIE REYNOSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1020 S ARROYO PKWY, PASADENA, CA 91105-3911
(626) 403-2794
Mailing address
16204 MALLOY AVE, CARSON, CA 90746-1027
(562) 599-9054
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/06/2016
Last updated
08/24/2024
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