Individual
BRENDA REYNOSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
7430 STANFORD AVE, LA MESA, CA 91942-9121
(619) 460-6534
Mailing address
7430 STANFORD AVE, LA MESA, CA 91942-9121
(619) 460-6534
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133V00000X
CMS
CA
Enumeration date
01/28/2016
Last updated
01/28/2016
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