Provider Demographics
NPI:1326534819
Name:REYNOSO, EVANGELINA (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:EVANGELINA
Middle Name:
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6295
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91909-6295
Mailing Address - Country:US
Mailing Address - Phone:619-409-2063
Mailing Address - Fax:
Practice Address - Street 1:46 3RD AVE STE E
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1770
Practice Address - Country:US
Practice Address - Phone:610-409-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist