| Doctor Name: | CARMEN VANESSA REYNOSO |
| NPI Number: | 1124159215 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | IMF43481 |
| Business Practice Address: | 40 Bennett Ave Apartment # 4 Long Beach, CA - 908032986 |
| Business Phone Number: | 5628338723 |
| Business Fax Number: | |
| Mailing Address: | 40 Bennett Ave, Apartment # 4 LONG BEACH |
| State: | CA |
| Postal Code: | 908032986 |
| Phone Number: | 7143438442 |
| Fax Number: | |
| NPI Enumeration Date: | 03/08/2007 |
| NPI Last Update Date: | 11/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225400000X |
| License Number: | IMF43481 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Rehabilitation Practitioner |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |