Provider Demographics
NPI:1275321275
Name:REYNOSO, BRIANNA ESMERALDA (MA)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ESMERALDA
Last Name:REYNOSO
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 GLENHURST CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5319
Mailing Address - Country:US
Mailing Address - Phone:818-388-7783
Mailing Address - Fax:
Practice Address - Street 1:19231 VICTORY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6321
Practice Address - Country:US
Practice Address - Phone:818-708-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist