Provider Demographics
NPI:1871069575
Name:REYNOSO, LAURA (NP, RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 FILLMORE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-4119
Mailing Address - Country:US
Mailing Address - Phone:626-278-0545
Mailing Address - Fax:
Practice Address - Street 1:11127 1ST AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-3110
Practice Address - Country:US
Practice Address - Phone:562-943-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027541363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner