Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 103G00000X | Clinical Psychologist | PSY24099 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY24099 | CA |
NPI | 1013084276 |
---|---|
Provider Name | Dr. Jose Trinidad Reynoso JR. |
First Address | Long Beach, CA 90806 |
Second Address | Long Beach, CA 90806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 17/06/2021 |