Provider Demographics
NPI:1386884898
Name:REYNOSO, ARMANDO
Entity type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:REYNOSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PASEO TIJUANA NO. 406-M1
Mailing Address - Street 2:EDIFICIO SIMNSA
Mailing Address - City:TIJUANA
Mailing Address - State:BAJA CALIFORNIA
Mailing Address - Zip Code:22010
Mailing Address - Country:MX
Mailing Address - Phone:619-407-7911
Mailing Address - Fax:
Practice Address - Street 1:4492 CAMINO DE LA PLZ
Practice Address - Street 2:SUITE 163
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-3003
Practice Address - Country:US
Practice Address - Phone:619-407-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20451591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
2045159OtherDENTAL BILLING