Provider Demographics
NPI:1922201557
Name:REZA, LORRAINE JANET
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:JANET
Last Name:REZA
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 1:1043 5TH PL
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-1949
Mailing Address - Country:US
Mailing Address - Phone:661-758-2701
Mailing Address - Fax:
Practice Address - Street 1:126 S H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6821
Practice Address - Country:US
Practice Address - Phone:805-735-5550
Practice Address - Fax:805-735-5616
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor