Provider Demographics
NPI:1972812048
Name:REYNOLDS, VANESSA (LVN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10662 1/2 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2135
Mailing Address - Country:US
Mailing Address - Phone:562-225-5559
Mailing Address - Fax:562-309-9997
Practice Address - Street 1:10662 1/2 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2135
Practice Address - Country:US
Practice Address - Phone:562-225-5559
Practice Address - Fax:562-225-5559
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198022164X00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse