Provider Demographics
NPI:1679451801
Name:REZA, CORINA MARIA II
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:MARIA
Last Name:REZA
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 MCLAUGHLIN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3511
Mailing Address - Country:US
Mailing Address - Phone:408-600-9590
Mailing Address - Fax:
Practice Address - Street 1:1505 MERIDIAN AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5353
Practice Address - Country:US
Practice Address - Phone:628-250-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician