Susan Jean Reynolds, RN, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

230910 Issued in CA

Practice address

9802 Woodbury Ave
Garden Grove, CA 92844-2819

Phone

(714) 663-6411

Fax

(714) 663-6470

NPI assigned

Mar 1, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Garden Grove Unified School District

  • Health Service Clinic/Center
  • Garden Grove, CA
  • NPI 1851429716
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154459287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20652 FARNSWORTH LN",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926465522",
            "telephone_number": "714-536-0348",
            "fax_number": "714-969-2647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9802 WOODBURY AVE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928442819",
            "telephone_number": "714-663-6411",
            "fax_number": "714-663-6470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "SUSAN",
        "middle_name": "JEAN",
        "credential": "RN, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "230910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PIN#",
            "identifier": "1458726",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "SS3066522",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Reyes
• Karla Reyes
• Mayoli Reyes
• Mayra Reyes
• Nina Alian Reyes
• Alyza Reynoso Villagomez
• Cynthia Reynoso
• Harrell M Reznick, PH.D
• Brian Seunghun Rhee, M.D
• Ernest Youngchan Rhee

• Pediatric Nurse Practitioner in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Pediatric Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.