Provider Demographics
NPI:1285921627
Name:REYNOSO, ALFONSO (DC)
Entity type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:REYNOSO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 VIA ENCANTADORAS
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-1833
Mailing Address - Country:US
Mailing Address - Phone:619-805-5610
Mailing Address - Fax:
Practice Address - Street 1:820 JAMACHA RD
Practice Address - Street 2:SUITE 103
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3205
Practice Address - Country:US
Practice Address - Phone:619-579-1068
Practice Address - Fax:619-579-5014
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor