Individual
MR. JACK REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
194 VIA BAJA, VENTURA, CA 93003-1240
(805) 760-7179
Mailing address
194 VIA BAJA, VENTURA, CA 93003-1240
(805) 760-7179
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN 265668
CA
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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