Provider Demographics
NPI:1679601207
Name:REYNOSO, MONICA SANDRA (MS)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:SANDRA
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 E BULLARD AVE
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5800
Mailing Address - Country:US
Mailing Address - Phone:559-321-7916
Mailing Address - Fax:559-446-1942
Practice Address - Street 1:1702 E BULLARD AVE
Practice Address - Street 2:SUITE # 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5800
Practice Address - Country:US
Practice Address - Phone:559-321-7916
Practice Address - Fax:559-446-1942
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist