Individual
MRS. AVUSE ANTIONETTE REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
CORONA-RINCON, 255 E. RINCON STREET, CORONA, CA 92879
(951) 817-5328
Mailing address
11383 PEPPER LN, BEAUMONT, CA 92223-7440
(951) 703-9722
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT30248
CA
Other
Enumeration date
04/15/2024
Last updated
04/15/2024
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