Provider Demographics
NPI:1134679368
Name:RECINOS, VIRYDIANA
Entity Type:Individual
Prefix:
First Name:VIRYDIANA
Middle Name:
Last Name:RECINOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10418 VALLEY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3600
Mailing Address - Country:US
Mailing Address - Phone:626-582-1423
Mailing Address - Fax:323-201-3216
Practice Address - Street 1:10418 VALLEY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3600
Practice Address - Country:US
Practice Address - Phone:626-582-1423
Practice Address - Fax:323-201-3216
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker