Provider Demographics
NPI:1952691453
Name:REYNOLDS, MARIA A (SPEECH THERAPY)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:SPEECH THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 S EL CAMINO REAL
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-9000
Mailing Address - Country:US
Mailing Address - Phone:760-729-5433
Mailing Address - Fax:760-729-1764
Practice Address - Street 1:2111 S EL CAMINO REAL
Practice Address - Street 2:SUITE # 200
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-9000
Practice Address - Country:US
Practice Address - Phone:760-729-5433
Practice Address - Fax:760-729-1764
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLP 184672355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant