Provider Demographics
NPI:1013084276
Name:REYNOSO, JOSE TRINIDAD JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:TRINIDAD
Last Name:REYNOSO
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 EAST 20TH ST.
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-218-4101
Mailing Address - Fax:562-218-0372
Practice Address - Street 1:240 EAST 20TH ST.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-218-4101
Practice Address - Fax:562-218-0372
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY24099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist